Creative Space

Broken & Beautiful

This month’s contribution to Creative Space is a poem and image authored by Tammy, both a survivor and an ISSTD Student and Emerging Professional (SEP) member.

As this poem illustrates, to call on something greater than ourselves has helped Tammy. Her spirituality is a source of strength and courage to live.


Committee Spotlight

Communications and Marketing Committee

Kate McMaugh, Committee Chair

The Communications and Marketing Committee has two main roles. The first of these is promoting ISSTD including its activities and services, both internally and externally. It also has a role in promoting issues relating to complex trauma and dissociation in the wider community, targeting health professionals, other relevant professionals and the general public. This includes increasing public awareness of complex trauma and dissociation.

The Committee had a little period of hiatus in between Chairpersons, but now is back in full swing. We met at the conference in March to plan the year ahead and had our first full-committee meeting of the year in July. We have lots of exciting projects underway in our ongoing role of promoting ISSTD activity including courses, webinars and conferences to members and non-members. Projects include:

A new Membership Brochure – A small project team of myself, Mary-Anne Kate and Na’ama Yehuda are working on a new membership brochure, which we plan to have ready for the ISSTD conference in Christchurch in November, and then able to be used in an ongoing way afterwards. Look out for a brand new, modern looking brochure we can use in conference tote bags, hand out in information stalls, or share with interested colleagues.

Facts Sheets for the Public – To meet community need ISSTD is developing a series of Facts Sheets for the general public. These will present factual information in a user-friendly manner, without getting into too much professional jargon or labelling. The written communication will be geared at a moderate level of education (e.g. have completed most of high school). Consideration will be given to low-literacy material at some stage, if that becomes an expressed need. At this stage we have five facts sheets in the final stages of development:

  • Trauma and Complex Trauma: An Overview
  • Post-Traumatic Stress Disorders
  • Trauma Related Dissociation: An Introduction
  • What are the Dissociative Disorders?
  • Getting Treatment for Complex Trauma and Dissociation

Once these are finalised the Committee will explore ideas for other facts sheets. It is really important that ISSTD, as the world’s premier organisation concerned with complex trauma and dissociation, is able to play a key role in educating the public about trauma and the disorders that can arise from trauma. Therefore any ideas from members are welcome! Please email me on if you have an idea for a Facts Sheet that would be useful for the general public.

Dissociative Identities Awareness Day – As part of promoting general awareness of dissociation, the Committee is busy planning activities for Dissociative Identities Awareness Day in March next year. Look out for a series of articles in ISSTD News, a social media campaign in the lead up to, and on the day itself, and some other special activities we have planned for this day. One really exciting part of this awareness day is that it gives ISSTD a chance to liaise with and work more with survivor groups to make this day really meaningful and educative.

Development of Video Marketing Content – One of our Committee Members, Mary-Anne Kate is driving a project to edit and use video footage of past ISSTD conference plenary speakers for marketing. The video footage of our speakers is a treasure trove of information, just waiting to be edited into smaller, marketable pieces which will be used on social media to both promote ISSTD and raise awareness about complex trauma and dissociative disorders. Stay tuned for more information in the months ahead.

The Communication and Marketing Committee has quite a few other projects planned as well as our ongoing role in promoting ISSTD webinars and conferences. We are keen to have new volunteers, so if you are interested in any form of marketing, promotion and communications, we are interested in you! If you love writing, editing, producing video content, planning promotions, or just have an idea – please contact me on

Committee Spotlight

Finance Committee

D Michael Coy, MA, LICSW, Treasurer and Chair, Finance Committee

Hello again from ISSTD’s Finance Committee! It’s hard to believe that a whole year has passed since my last update.

As I near the completion of my two-year appointment to the role of Treasurer (after Christine Forner was voted President-Elect in late-2017), I am pleased to share with you where we’ve been over the past year and where we’re headed in 2020 and beyond.

Since last August, the Finance Committee has overseen:

  • ISSTD’s ongoing commitments to repay funds to the Education and Research Fund and to increase savings, each at a rate of $350.00 per month, maintained on schedule throughout 2018 and 2019. (Formerly known as the Development Fund, this grant was developed with the mission of supporting programs and initiatives that further education, assessment, treatment, and research of the dissociative disorders);
  • A comprehensive review of ISSTD’s existing financial policies and procedures;
  • The creation of a monthly schedule of financial tasks for the entire calendar year, to better ensure internal accountability and smoother communication;
  • The development of a monthly financial dashboard/narrative report, prepared by the Treasurer, which distills the monthly financial documents into an easy-to-read format and highlights areas of revenue growth, areas for caution, and ‘red flags’ that require closer attention;
  • An overhaul of the annual budget document in preparation for the development of longer-term financial projections in coming years;
  • The conclusion of the 2018 ‘35 for the 35th’ anniversary fundraising initiative to support the development of the new website. (This effort was not as successful as we had hoped, but it did offer us a lot of insight into how we can craft more effective appeals in the future.);
  • Financial co-management of the development of the new ISSTD website, including ISSTDWorld;
  • Financial co-management of most successful Annual Conference (in 2019) that ISSTD has seen in many years; and,
  • A significant increase in revenue, owing in large part to improved collaboration within ISSTD and a more adventurous outlook toward the possibilities—not only for maintaining, but also expanding, ISSTD’s global relevance and presence.

As you can see, the Finance Committee has in the past year has focused heavily upon policies & procedures and monitoring a couple of pretty big initiatives within ISSTD. Additionally, the Treasurer drafted a proposal (subsequently approved by the Board of Directors) which mandates that all Board members are required to serve a 6-month rotation on the Finance Committee in their second year of service. This policy was developed with the aim of supporting Board members to strengthen their sense of fiduciary responsibility to the organization and its continued growth.

And, here’s what’s to come:

  • The development of 3-to-5-year budget projections that integrate with ISSTD’s Strategic Plan using measurable progress/achievement benchmarks;
  • Reinvigorating a Fundraising Committee (a 2018 goal which was put on the ‘back burner’ due to other, pressing projects);
  • Revising the current budget structure to improve strategic planning and better reflect how ISSTD serves its members (that’s you!) today; and,
  • Further developing interrelationships amongst different ISSTD committees with budget (revenue and/or expense) responsibilities to ensure closer adherence to ISSTD’s annual budget.

ISSTD is really growing (back) into a vibrant organization serving the needs of its members in ways both familiar and contemporary, and I feel pleased that the Finance Committee has played a vital role in that growth. I am very excited about what the future holds, and I hope you are, too. Thanks for reading!

Regional Conferences

Exciting New Conference Exploring the Body and Trauma: Early Bird Registration Now Open

Increasingly therapists are being encouraged to work with the body, in addition to, and integrated with the more traditional ‘talking therapies’. Indeed, we are earning more and more about the impact of trauma on the body – and that working with the body can help heal trauma. In this context ISSTD is excited to announce a new one-day conference in Portland, Oregan: The Body in Traumatic Dissociation.

This conference, held on November 1, 2019, is being run by ISSTD Board Members D. Michael Coy and Lisa Danylchuk with past Board Member, Paula Thomson. These experienced presenters and therapists promise to deliver a great day of focused and creative training.

An Outline of the Day

The day will open with Lisa Danylchuk leading a session on Healing Trauma Through Yoga. This session promises to engage you fully – beginning with a simple experiential yoga practice. Lisa will then discuss developmental trauma and its impacts on the mind and body, and will explore how yoga practices can help heal symptoms of PTSD and complex, developmental trauma. The session will include a discussion of the provider’s experience, both practicing yoga personally, as well as offering yogic practices to trauma survivors.

In the second session of the day Paula Thomson will present on the Dynamic Body: Autonomic Nervous System, Allostasis, and Stress Responses. Come along and learn all about the way behavior is shaped by environmental challenges, both present and past and how the two branches of the autonomic nervous system, the sympathetic and parasympathetic branches, modulate all internal bodily states to meet the demands of these past and present challenges. This session will also use case study examples to illustrate these responses and describe simple tools to stabilize autonomic stress responses in patients and therapists. Participants will have an opportunity to share their clinical experience and to ask questions related to this topic.

Paula will follow up this session with another session entitled: Embodiment: Cognition, Memory, Emotional Distress, and Disembodied Dissociation. In this session she will explore embodied cognition, body memories, emotional distress, and disembodied dissociation. Practical strategies will be explored including: assuming body postures to evoke emotional memories, modalities to normalize and enrich these body postures, and creative processing to enhance resilience. Pathological disorders associated with embodied/disembodied states will be examined from an embodied orientation (i.e., bradycardia, chronic fatigue, chronic pain, disordered eating, self-injurious behaviors, depersonalization, toxic shame, and PTSD symptoms).

The final session, led by Michael Coy, has the intriguing title: Is That Mine or Yours? Feeling the Untold Story in Therapy. This session will explore the phenomena of non-verbal communication via mirror neurons that can manifest in the therapeutic relationship. This attunement may take on a very powerful dimension in the context of working with people who have complex trauma and dissociative symptoms. The session will also describe dissociative attunement, where the therapist serves as a “micro-tonal tuning fork” vibrating in resonance with the client’s dissociated emotion, sensation, or other sensory information. Different manifestations of dissociative attunement will be discussed, as will contexts in which it might occur, and the observed impact upon the client (and treatment) of an aptly-framed and appropriately-timed reflection of the dissociated experience. Additionally, the toll that this level of ongoing, deeply-felt resonance can have upon the therapist, as well as strategies for emotional cleansing, will be addressed.

And Portland itself….

The conference will be held in the Kimpton Hotel Monaco Portland, a delightful location, built around 1912 and recently described as “the Most Beautiful Hotel in Oregon”. This hotel makes a great base to explore the city of Portland, so stay a day or two. There’s plenty to do.

Do you like to shop? Portland may well be the place for you. With no sales tax, Portland is a haven for shoppers, with a wide variety of retailers. Don’t go past Powell’s City of Books. The area is also known for art galleries, museums, gardens and its wonderful street food.


Early Bird Registration is now open, but ends September 30. Don’t miss out on this opportunity to get a day of professional training at the lower price. Student and Emerging Professional discounts are available. For more information visit the conference website!

Letter From The President

Life at the Border

Christine Forner, BA, BSW, MSW

This month I had the privilege of visiting the city of El Paso, Texas and Ciudad Juarez, Mexico. As one of the keynote speakers at the Trauma and Resilience in the Border Land Conference I was able to see and hear first-hand stories of what is happening at the Border. What I witnessed is both horrifying and brilliant. As a Canadian who lives very far from the US/Mexican Boarder, I have been shown terrible images that depict a very clear racism. I have been shown through the media that Mexico and Mexicans are people to be afraid of – and this was a totally false notion.

I was struck by the stories of the children who are in these detention camps. As only lawyers and child advocates are allowed into the camps, I relied on speaking with individuals who are working with these children. What I heard were stories of wasted human potential. Most of the stories that I heard were about children and adolescents who had so few choices that they made a life-and-death decision to travel to the US, avoiding further violence, in an effort to find safety. These were stories of young adolescent men who were never formally educated, but who have learned to read on their own and now want to read everything they could get their hands on. Stories of young men who lost every family member they had, but found other young men on their journey, who had no interest in harming others or joining gangs, but who found family with each other. I heard stories of mothers who were doing what they could to save their children. I heard stories of fathers and grandfathers leaving messages of hope within folk tales of how to conduct oneself with dignity and honour. I heard stories of social workers, psychologists, lawyers, teachers, child advocates and other community members going out of their way to do what they can to help these children find safety. I heard the accounts of the wonderful souls they have met. It was the helpers whose stories were loud; not the stories of those doing harm.

One evening we went into Juarez for dinner. I found it fascinating that I was not asked to produce any I.D. to get into Mexico. They did not treat me like I was a potential criminal. I was treated with a casualness that was pleasantly benign. The food was outstanding, as were the people. There were crowds of people gathering to enjoy their Saturday evening, expressing themselves through art, culture and dancing. My experiences, in what I was told was the most dangerous city in the world, was as non-eventful as it would be anywhere else in the world.

It was coming back into the US where the tone changed. I was confronted with the sight of large German Shepherd dogs on guard, razor wire around and on top of everything, armed guards yelling that we were not allowed to take pictures, and many “things” that looked ominously covered up with camouflaged. It was frightening, honestly. Being a Canadian I have traveled into the US countless times throughout most of my life. This was one of the most intimidating border crossings I have ever done. The intimidation seemed so backwards.

In this situation I had to really examine what I have been taught and what biases I have. I was more afraid walking into the United States than I was in Mexico. This statement may sound racist, and by no means is this my intention. If I am sounding racist, I ask for forgiveness. My intention of this commentary is to state the opposite. It is intended to highlight how much propaganda I am being fed on a daily basis and how this has influenced me, as well as many others. I feel like I’m being gaslighted. I am being told through media that the safe place is dangerous and the dangerous place is safe.

I expected a scene from the move Sicario. I was expecting to see droves of humans all begging to get into the US. I was expecting to see huge poverty. What I actually saw was the same as I see here…humans taking care of humans and going about their business.

I was left considering how I have been led to believe that there is a huge crisis at the border. I saw no crisis coming from the Mexican side. I considered how I have been led to believe that there are horrors happening. It is odd to be in the middle of someone else’s projection.

What I did witness was humans doing everything they can to help other humans. I heard story after story of how everyone is trying to help out as best as they can. How Uber drivers are volunteering their time, how mothers and grandmothers are trying to feed, clothe and care for those who are missing their families. I heard stories of young people bonding with other young people and wondering how they too can help others.

There is a crisis at the border and that crisis is called racism. I feel very fortunate that I was invited to this lovely place in the world. I feel gratitude to all of the people that I met who are doing what they can to help others. I am thankful that I was able to meet so many humans working very hard to support other humans. I am grateful that I belong to a society that works hard to look at these hurtful truths right in the face and finds the humanity under all the pain and suffering. Our strength is each other and our collective wisdom that human connections are a basic human right.

And as an after note: I have just found out that there was another mass shooting in El Paso and reports that the crime was racially motivated. As stated above, the information that is being disseminated in mainstream media and social media about the “crisis” is not what I saw. The crisis is still the same crisis that most people face every day: the crisis of trauma, abuse and neglect. Trauma, fear, neglect and harm are at the root of much of our social ills. This makes sense as we are fundamentally caring and bonding creatures, but when there is not enough safety in childhood all sorts of ill-effects occur. The hatred that one group feels towards another group is trauma based. Selfishness and greed can also be seen as a symptom of trauma.

Solutions can also be found in education about, treatment for and research into complex trauma and dissociation, and the root causes of both. I encourage all of you to write, teach, work and research in any way you can so that what we do becomes common knowledge. A clear path towards healing can be found within the ISSTD vision that “social policy and health care will address the prevalence and consequences of chronic trauma and dissociation, making effective treatment available for all who suffer from the effects of chronic or complex trauma” and our Mission Statement that states “ISSTD seeks to advance clinical, scientific, and societal understanding about the prevalence and consequences of chronic trauma and dissociation”. The more we share what we know, the more we can guide policies and cultural norms to places that are more aligned with our common human need for care, safety and security in our world. 

Thank you Dee, Fabiola and Cheri for the hospitality, heart, soul and wonderful El Paso care.

Regional Conferences

‘Changing Landscapes’ Conference, Otautahi/Christchurch, New Zealand: Early Bird Deadline Approaches

Kate McMaugh, Editor, ISSTD News

There is just one month to go until the early bird deadline expires on the ISSTD conference in Otautahi/Christchurch, New Zealand: Changing Landscapes – Innovations in the Treatment of Trauma and Dissociation. Don’t miss this last chance to join the world’s leaders in complex trauma and dissociation, for a very affordable price.

While previous bi-national ISSTD conferences have been held in Australia, this is the first ever ISSTD conference to be held in New Zealand. The conference offers a rich opportunity to learn from and network with local and international speakers, with the size and scope of the conference evidence of the growing importance of complex trauma and dissociation research and treatment in New Zealand and Australia.

Changing Landscapes

As the title suggests, the conference has a theme of ‘Changing Landscapes’. This has many layers of meaning and the conference will certainly explore the changing landscape of the complex trauma and dissociative disorders field. However, it will also explore the ‘changing landscapes’ for this region, which has been recovering from devastating earthquakes in 2010 and 2011, while more recently responding to one of the world’s worst mass shootings on 15 March 2019. In addition, New Zealand has an historical trauma caused by colonisation and this too will be explored as part of the landscape of New Zealand (Aotearoa in Maori, the language of the indigenous first people of the land).

Pre-Conference Workshops

The conference will kick off on Friday with a series of half and full day pre-conference workshops including:

  • Michael Coy and Jennifer Madere presenting on An Introduction to the Multidimensional Inventory of Dissociation;
  • Michael Salter and Warwick Middleton presenting on Victims, Perpetrators and Organized Abuse;
  • Christine Forner and Mary Anne Kate will collaborate to present Dissociation 101, the ever-popular all-day introduction to the field of Dissociation and Complex Trauma;
  • Rochelle Sharpe Lohrasbe will present an all-day workshop entitled: When Experience Exceeds Integrative Capacity: Sensorimotor Psychotherapy, Autonomic Nervous System Dysregulation and Somatic Resources;
  • Rick Hohfelor and Martin Dorahy will present: When Nothing Else Works: Chronic Self-regulation via Shame and Dissociation – Formulations and Treatment Considerations; and
  • Naomi Halpern will present a half day workshop entitled: Which Brain am I?: Identifying and Targeting Appropriate Interventions in the Triune Brain in Complex Trauma Disorders

Friday will be concluded with a series of evening social events, which will allow attendees to experience Otautahi/Christchurch. Join fellow delegates for activities such as a walking tour of Otautahi/Christchurch or visit the International Antarctic Centre. (Tickets will be available at extra cost prior to the conference.)

The Conference Begins…

The main conference begins on Saturday with a powhiri (a traditional Maori cultural opening ceremony) followed by four plenary workshops:

  • ISSTD Past President and well-known author Kathy Steele will present on: An Integrated Systemic Model for Treating Trauma-related Dissociation.
  • Current ISSTD President, Christine Forner will present on Mindfulness in the World of Dissociation.
  • ISSTD Board Member, Michael Salter will present on Constructions of Complex Trauma and Implications on Women’s Wellbeing and Safety from Violence.
  • Past President of ISSTD, Martin Dorahy will present on Dissociative Identity Disorder: Clinical Phenomena Under the Laboratory Spotlight.

The day of education will end with a plenary panel featuring Rick Hohfeler, Joan Haliburn, David Leonard, Matt Ball and Susie Farrelly, moderated by Warwick Middleton. This panel, which will explore the interface between psychosis, dissociation and Borderline Personality Disorder, promises to provide a rich discussion and exploration of issues right on the cutting edge of the field.

After this, join everyone for the conference dinner during which we will be entertained by a Maori Kapahaka group in full costume. This promises to be a truly wonderful cultural performance, not to be missed (Separate registration will be required and guest tickets are available).

Sunday will feature a wide variety of both half day and full day workshops. With such diversity, there will be something for everyone. Topics include:

  • Working with alternatives to self harm;
  • Updates on clinical and research issues from the Trauma and Dissociation Unit, Belmont Hospital, Brisbane;
  • Workshops exploring complex trauma treatment in child and adolescent clinical populations;
  • Workshops exploring a wide range of treatment approaches;
  • A workshop exploring and responding to earthquake trauma;
  • A workshop exploring the historical and intergenerational trauma of colonisation, with particular reference to the Maori experience; and
  • A panel discussion exploring the psychological impact of and community responses to the Match 2019 shootings in Otautahi/Christchurch.
  • For a full list of Workshops please see the online program.

The conference will conclude with a traditional closing ceremony.

Stay a little longer

However, the people of Otautahi/Christchurch invite you to linger a little longer in this most beautiful corner of the world. Explore the unique city of Otautahi/Christchurch as it completes its re-build from the earthquakes, in a manner that showcases modern urban re-generation, while staying true to its heritage and traditional English feel. Visit the botanical gardens, dine out, or go punting on the Avon River.

Otautahi/Christchurch itself is is located in Canterbury, a region known for beautiful landscapes of green plains, pristine lakes and snow-capped mountains. Visit the Aoraki Mount Cook National Park which hosts the country’s highest mountain and the 27km-long Tasman Glacier.

In the nearby Banks Peninsula the French-influenced town of Akaroa is noted for its beautiful harbor and dolphin-swimming encounters. In other nearby towns it is possible to go whale-watching, see ancient Maori rock art or visit vineyards. Take some time to explore the hot springs, beautiful lakes, and wineries. Go cycling, hiking or try one of the adventure sports New Zealand is famed for. For those of you travelling from afar, make this conference the start of a holiday of a lifetime: explore all of New Zealand, one of the most unspoilt and relaxed destinations in the world. Consider hopping ‘over the ditch’ and visit Australia as well.

Don’t miss out on Early Bird Prices and Group Discounts

Early Bird Registration expires on 31 August. Generous Conference fee discounts are available for members of ISSTD and further student discounts are also available. For further information look at the registration details on the conference website.

Group Discounts are also available – with 10% off for groups of five or more and 15% off for groups of ten or more. Those wanting to make a group booking are advised that one representative of the group will need to contact ISSTD with a list of group member names. Additional individuals can be added to the group at a later date, but all group registrations must be completed by 31 October 2019. Please contact ISSTD about group discounts at

Trauma & Dissociation in the News

Prostitution, Modern Sexual Slavery, Sex Trafficking and Bondage of the Human Mind: A Reflection Regarding Our Times

E Hitchcock Scott, PhD, LPCC917

Other than TV, the first time I heard about sex for hire, I was sixteen years old. I had just interviewed for my first job. During the interview, I quickly decided that I was not interested in the advertised role of emptying vender machines. As I was preparing to leave the interviewer said, “I have an escort service”. When I asked what that meant he explained, “All you have to do is get dressed up and go out with men for dinner and a show. You will make a lot of money.” Then he said, “There are men who would find you very attractive”. I was puzzled because I knew that I looked very young for my age. I was fortunate, my privilege protected me. I was able to say, “I need to ask my mother,” and leave.

But what of others less fortunate? When we think about this, it is worth noting that July 30th is the International World Day Against Trafficking of Persons. This World Day led me to reflect, as much as possible in a brief paper, about how we define and understand sex for hire, and how that sits alongside our understandings of consent.

While thinking about the meaning of consent, I could not help but think of bondage: not just bondage of the body, but of the mind and the way bondage of the mind restricts a fully informed or “knowing consent”.

I can remember the first time I heard about human bondage. It was in 1987 when I was working as a new counselor in Dallas, Texas. An extremely bright, middle aged client, with a successful career as a lawyer, began weeping in an hysterical panic. Shaking and covering her face, she said in a child’s voice, “And, and, and … he put a loaded gun in my vagina and said he would kill me if I screamed or told anyone.” At that moment the oppressed scream from 45 years earlier emerged with so much childlike angst I had to concentrate in order to suppress my own tears.

A few months before, the co-owner of the counseling center had warned me that I would hear about bondage. As she spoke, my mind drifted to consensual adult pseudo-sadomasochism. The owner and my supervisor, sensing that I had missed the point, looked me in the eye and said, “Of children.” I swallowed and said quietly, “Oh.” Even then I truly had no idea what she meant. That client’s scream, made it all too clear.

How can it be that one of the most wealthy, prestigious, “proper” Christian neighborhoods in the United States harbors this kind of criminal activity outside our sight and awareness?

And what does bondage mean when it involves the mind, not just the body? In the book Incest-Related Syndromes of Adult Psychotherapy, Dr. Richard Kluft reveals a conversation he had while he was traveling in Italy. Kluft was talking with a man in a bar who revealed that he was a pimp. The pimp volunteered, in a braggart sort of way, that the best prostitutes, like the two sitting with him, had been initiated to the world of sex by their fathers.

The pimp said that he looks for certain qualities in women he selects for sex workers, “Beauty, yes. Sexual expertise, somewhat. That can be taught easier than you think. What is important above all is obedience. And how do you get obedience? You get obedience if you get women who have had sex with their fathers, their uncles, their brothers——— you know, someone they love and fear to lose, so that they do not dare to defy. Then you are nicer to the women than they ever were, and more dangerous as well. They will do anything to keep you happy. That is how.” (Kluft, 1990, p. 25).

Yes, this is very shocking, but in fact, research suggests that the majority of prostitutes, as many as 60% or more, were sexually abused as young children, not necessarily by their fathers, but by a much older and often trusted person (Silbert & Pines, 1981).

Many prostitutes acknowledge that the early abuse has restricted their life choices, but they do not feel as if they have alternatives to prostitution, due to problems such as lack of education, low self-esteem, early pregnancy, poor health, sexually transmitted diseases, or mental health conditions. 

I have heard prostitutes, a few of whom were my clients, vehemently deny that prostitution as a career choice was associated with their early childhood abuse. Once, a very sophisticated call girl, when disclosing her profession for the first time, explained to me, insisted really, that she was in charge, not the Johns. While she was speaking, I could not help but notice the lack of congruence between her words and dress. She wore tiny, pink, plastic little-girl barrettes in her hair, black patent Mary Jane shoes that pointed inward as she fidgeted and a plunging and very revealing buxom décolletage.

The chains of her early trauma seemed to have kept her mind stuck in childhood even though her body was aging. If this is so, then how is prostitution a choice?

Although some consider prostitution a choice and define it differently from modern slavery and human trafficking, I see parallels. Exactly how different can prostitution be from modern slavery when there are such high levels of early childhood trauma and dissociation within and across the population. How can a sexualized child ego-state, sequestered within an adult human mind defend against predatory controllers? Thirty years ago, an adult client of mine explained how her “Pimp” called out a child part and demanded that she hand over all of her money, not just a portion. In fact, studies show that women in prostitution have much higher rates of dissociation than the general population (Ross, 2004) The prison bars of the mind are invisible and, when left untreated, more powerful than steel.

Unfortunately, the invisibility of those “prison bars of the mind’ undermines detection and intervention by those who could help. In fact, modern slavery or human trafficking violations are sometimes confused with domestic violence, or problems with employment laws, immigration laws, and breaches of civil or human rights (Machura et. al., 2019).

Margaret Thaler Singer, in her book, Cults in Our Midst, describes a class of victims as “those who have been in situations of enforced dependency” (Singer, 1995). This term appears to fit those involved in various forms of the sex industry, no matter the age, gender, race, or self-professed willingness.

In America, victims of human sex trafficking, in particular, are often afraid to seek help because in many states, even sexually exploited children and youth are remanded to the justice system. Instead of being treated as a victim in need of social services, there is a risk of arrest for victims of human trafficking. This problem is complicated when the person being trafficked or coerced into prostitution is also an undocumented immigrant.

Another problem is that due to the ways and means of coercion commonly used by traffickers, there are victims who do not perceive themselves to be victims, therefore they do not think there is anything to report. Machura et al (2019) writes:

Modern slavery is typically defined in terms of exploitation through the utilization of victim vulnerabilities. Cases are not only characterized by violent acts and threats, but also by the manipulation of victims, even to the point that they may claim that they are acting under their own free will. Thus, typical examples may include laborers who toil on fields under abhorrent conditions or prostituted individuals who believe that they are in a consensual relationship with their pimps. Stereotypical cases often associate modern slavery with human trafficking (or human smuggling) and evidence suggests that large numbers of individuals are trafficked for the purpose of slavery. However, modern slavery also involves the exploitation of local people and these cases are being exposed more frequently.  (pg 202).

There are also myths that the problems of modern slavery, which includes child sexual slavery and trafficking, are located primarily in third world countries like Thailand. Yet, America, like all nations in the world, has a significant child sex trade problem, although estimates of its prevalence are difficult to determine, given the hidden nature of the phenomenon (Miller-Perrin & Wurtele, 2017; Powell, Asbill, Louis & Stoklosa 2018). Sadly victims can go on to become perpetrators (Baxter, 2019).

If it true that sex trafficking is the fastest growing illegal industry in The United States of America, then how much more often are children being approached today, than when I was sixteen? To complicate the problem, today an offender can approach and even coerce a child from inside the family home, via the internet. According to Interpol/Europol, over 80 percent of adolescent provocative selfies posted on social media end up on adult web sites (Europol, 2017). Admitting that the veil between a healthy middle-class society with traditional values, and the criminal world, may be much thinner than we have assumed, challenges our assumptions. It is difficult to digest information that this may not a safe and fair world. Yet, coming to terms with this uncomfortable truth will help us as a society protect children better.

However, there were factors in the escort service scenario above that protected me. The outcome could have been very different if I had been a teenaged mother; a person of color; or what if I had an undocumented status; if my children or younger siblings were hungry or cold; if there was a language barrier; or I was running away from an abusive family; or I was transgendered.

The truth is, the criminal sex industry has a long history, is here still, and is growing quickly. Although prosecutions occur more frequently now, the profits of reselling a child over and over is calculated by some to be worth the risk.

Our clients may be reluctant to disclose their past or current involvement in the sex industry due to the shame of being a target, victim and/or a perpetrator. It is therefore vital that we be fully present with our clients and suspend judgement. This in itself is easier when we are well informed, not just about the psychological phenomenon of the sex industry, but also the cultural, sociological, political and economic factors that keep victims and perpetrators trapped. We must challenge the “us or them” divide, the separation we create to feel better, safe and distant. With regard to the future world we wish to create, all children must be our children.


Baxter, A.L.A (2019): When the Line between Victimization and Criminalization Blurs: The Victim-Offender Overlap Observed in Female Offenders in Cases of Trafficking in Persons for Sexual Exploitation in Australia, Journal of Human Trafficking, DOI: 10.1080/23322705.2019.

Europol (2017)

Kluft, R. P. (1990). Incest related syndromes of adult psychopathology. Washington DC: American Psychiatric Press, Inc.  

Machura, S., Short, F., Hill, V.M., Suddaby, C.R., Goddard, F.E., Jones, S.E., ….& Rouse, C.A (2019). Recognizing Modern Slavery, Journal of Human Trafficking, 5:3, 201-219, DOI: 10.1080/23322705.2018.1471863

Miller-Perrin, C. & Wurtele, S.K. (2017) Sex Trafficking and the Commercial Sexual Exploitation of Children, Women & Therapy, 40:1-2, 123-151, DOI: 10.1080/02703149.2016.1210963  

Powell, C., Asbill, M., Louis, E. & Stoklosa, H. (2018) Identifying Gaps in Human Trafficking Mental Health Service Provision, Journal of Human Trafficking, 4:3, 256-269, DOI: 10.1080/23322705.2017.1362936 

Ross, C.A., Farley, M& Schwartz, H.L.  (2004) Dissociation Among Women in Prostitution, Journal of Trauma Practice, 2:3-4, 199-212, DOI: 10.1300/J189v02n03_11  

Silbert, M. H. & Pines, A. M. (1981). Sexual child abuse as an antecedent to prostitution. Child Abuse and Neglect, 5(4) pp. 407-411.

Singer, M. T. (1995). Cults in Our Midsts: The hidden menace in our everyday lives. San Francisco: Jossey-Bass Publishers.

Special Interest Groups

Potential New SIG: Trauma and Transgender and Gender Non-Conforming (TGNC) Experience

H.L. “Lou” Himes, PsyD

Gender is a complex aspect of human development and identity, which forms in concert with, but independently from biological sex and sexuality. Yet, gender is often equated with biological sex and/or reduced to a simple rigid, binary construct which imposes separate, distinct sets of norms on those deemed men or women. More and more, with the help of good theory and the patience of our clients, mental health professionals are beginning to understand the true complexities of gender, the distinct developmental processes inherent in gender identity development, and the detrimental effects experienced by those whose experiences of gender do not fit neatly into an overly simplified gender-construct.

As trauma-informed therapists, it is becoming more common for transgender and gender-non-conforming (TGNC)1 individuals to find their way into our consultation rooms. Even in the best of circumstances (such as a young child expressing cross-gender identity to accepting and supportive parents), TGNC individuals cannot receive accurate mirroring of or attunement to their internal experience until they can first acknowledge and reveal (perhaps in unspoken ways) their identity to others (Fraser, 2009; McBee, 2013). This leaves TGNC individuals, particularly children, in a prolonged state of emotional isolation and “hiding.” Their dependence on caregivers, who may reject them, can force these vulnerable children to rely on dissociative processes to hide their identities from themselves and others. In short, the very fact that one is TGNC leaves an individual vulnerable to psychological distress and may result in trauma.

When a patient presents as both TGNC and DID, the level of complexity in the work grows exponentially. Therapists often need to be educated regarding TGNC issues in order to make important distinctions in treatment goals, allay patient fears, and to guide the work in a non-pathologizing manner. An understanding of the processes of dissociation, comfort with TGNC identities, and a basic level of knowledge regarding TGNC issues (e.g., terminology, cultural norms, and healthcare concerns) are imperative to meet the needs of these deeply vulnerable patients. This includes making oneself familiar with other organizations, such as The World Professional Organization for Transgender Health (WPATH), that focus on setting standards for health care professionals who work with TGNC individuals.

In order to address the needs of TGNC patients, some therapists may begin their own personal research into TGNC issues, while others may be tempted to rely on their patients to educate them. Given the ways in which TGNC people have often had to parent themselves—a side effect of hiding a part of oneself that others do not have access to, as well as a potential lack of appropriate parental presence—it is important for therapists to show interest in and care for their TGNC patients by seeking education and understanding of TGNC issues outside of the therapeutic relationship.

Ultimately, working with TGNC patients creates complex challenges for any clinician. How do we work with such a socially and psychologically vulnerable population in a manner that supports individuation, identity-development, and healing from complex trauma?


As a TGNC identified therapist myself, it might seem that I was naturally suited to work with TGNC individuals; however, this was not my area of focus right out of graduate school. In fact, my first TGNC patient sought me out. He saw me at his college counseling center (in a markedly patriarchal and religious institution) and decided that I looked “queer enough” that I might be able to help him.

As a result of this young man seeking me out, I decided to receive supervision from a psychologist who has led the way in working with TGNC patients. Through that supervision, I gained many of the skills necessary to work ethically and competently with TGNC folks. Since then, I have worked with dozens of TGNC individuals in various stages of social and physical transition; with those seeking long-term psychotherapy, and providing surgical support letters after a short period of evaluation. I have also provided supervision and education on TGNC related psychotherapy to pre-doctoral and licensed mental health providers and offer consultation and psychoeducational seminars to individuals and organizations who are seeking to provide more competent healthcare to TGNC folks.

Working with TGNC individuals quickly shed light on my own limitations in understanding and working with complex trauma. As my involvement with ISSTD has grown, I find myself with more and more questions regarding how to best support my deeply traumatized, TGNC patients.

With the opportunity ISSTD offers through their support of SIGs, I hope to create a space for therapists to learn about TGNC identities, a space to ask hard questions about the intersections of trauma, dissociation and identity, and to foster an environment of mutual edification and support for the both challenging and rewarding work that comes with sitting together with TGNC people. If you are interested in being a part of this new SIG, please email me directly at

  1. TGNC is a term that indicates various forms of transgender experience across a broad spectrum, including both binary and non-binary identities, those who seek physical transition, and those who do not.

Fraser, L. (2009). Depth psychotherapy with transgender people. Sexual and Relationship Therapy, 24:2: 126-142.
McBee, C. (2013). Towards a more affirming perspective: Contemporary psychodynamic practice with trans and gender non-conforming individuals. Advocates’ Forum, The University of Chicago.

Committee Spotlight

Committee Spotlight: UN Taskforce

Karen Hopenwasser, MD

These past months have been busy times for our ISSTD activity at the U.N. On April 29, 2019 we (Karen Hopenwasser, Ariel Lublin and Robert Schwab) participated in a day long activity, Interactive Multi-Stakeholder Hearing on Universal Health Coverage. We submitted a jointly written statement with the Committee on Mental Health on the necessity of universal, trauma-informed mental health care. Though we were not called upon to read our statement it was an opportunity to network and dialogue with others.

Then on June 11, 2019 I spoke at a side panel presentation during the 12th session of the Conference of States Parties to the CRPD (Convention on the Rights of Personal with Disabilities). Our panel presentation was entitled Ensuring Access to Community Based Mental Health Services for People with Psychosocial Disabilities – International Standards and Innovative Practices. This was sponsored by the Missions from India and Israel, the Israeli Mental Health Association, ISSTD, and several other organizations. At this presentation I spoke on the concept of Trauma-Informed Mental Health Care. One of the themes I covered was the relationship between Adverse Childhood Events (ACEs) and later medical and mental health problems. It was another opportunity to network with organizations working around the world and to step up the dialogue about trauma-informed services. There was a genuine excitement in the room discussing the development of trauma-informed services.

Going forward we are preparing for World Mental Health Day on October 10, 2019. World Mental Health Day is sponsored by the World Health Organization (WHO) every October 10th, with the overall objective of raising awareness of mental health issues around the world and mobilizing efforts in support of mental health. The theme for 2019 is Suicide Prevention: Moving Towards Improving Mental Health. Again, we will develop an aspect of the program that addresses childhood relational trauma and suicidality in adolescence and adult life.

Our work at the U.N. is largely guided by the activities of the NGO Committee on Mental health (NGO CMH), a cluster of NGOs dedicated to global mental health care. I have served as a Member at large on the executive committee of the NGO CMH for two years and will serve a second two year term beginning June 2019.

Anyone interested in becoming involved is encouraged to join the NGO CMH here. As a member of this committee I co-convene the Trauma Working Group. We are a growing sub-group of professionals engaged in the advancement of trauma informed mental health care

Regional Conferences

Austin Regional Conference: Early Bird Registration Now Open

Colin Ross presenting at an ISSTD Conference, Sydney 2011

ISSTD’s next Regional Conference will be held in Austin, Texas on October 4, 2019. This workshop Dissociative Identity Disorder: How To Recognize It and Principles of Treatment will be a full day event led by ISSTD Fellow and Past President, Dr. Colin Ross, known as a world-leader in the treatment of Dissociative Disorders, and Melissa Engle, who is co-founder and co-owner of Healing Springs Ranch, a Licensed Professional Counselor and a Registered Art Therapist.

Melissa Engle

Dr. Ross and Melissa Engle will describe how to recognize dissociative identity disorder (DID) and the principles of its treatment. This is planned to be a highly practical and clinically relevant workshop, enriched by discussion of clinical examples gathered through the many years of experience of the presenters. The morning will cover the symptoms of DID and how to assess it. Copies of the DES-II and the DDIS will be given to all participants. The later sessions will cover essential elements of treatment of both DID and partial DID. This will include dealing with the problem of host resistance; talking through to the voices; fostering inter-personality communication and cooperation; and grounding and stabilization strategies.

Early Bird Registration is now open for this conference which is likely to be an essential training for beginners, as well as a useful refresher for more experienced clinicians. Generous discounts apply for ISSTD Members. Don’t miss out!

Austin, Texas

The one-day event will be held in Austin, Texas, so if you plan to travel, why not have a few days stop over in this delightful town. Known as the live music capital of the world, Austin has a vibrant entertainment life with more than 250 music venues. It also has great restaurants, art galleries and some stunning outdoors to enjoy. Austin enjoys more sunny days than most, so this is also the ideal place to enjoy a sunset bat cruise on Lady Bird Lake, hiking, bike riding or paddling.

For more information, and to register, visit the Conference Website!