Psychological Trauma: Theory, Research, Practice, and Policy © 2014 American Psychological Association

2014, Vol. 6, No. 5, 482– 493 1942-9681/14/$12.00 http://dx.doi.org/10.1037/a0035763

The Psychological Experience of Child and Adolescent Sex Trafficking in

the United States: Trauma and Resilience in Survivors

Stacy J. Cecchet John Thoburn

Kennedy Krieger Institute & Johns Hopkins University Seattle Pacific University
School of Medicine

To date, little empirical data exists examining the psychological experience of survivors of child sex
trafficking in the form of prostitution, nor does current scientific data suggest how American women and
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

children are recruited into the sex trade and sold for sex within the United States. This qualitative research
This document is copyrighted by the American Psychological Association or one of its allied publishers.

study analyzed the narratives of interviews with 6 survivors of child and adolescent sex trafficking to
assess factors that influenced their ability to survive, leave the sex trade, and reintegrate back into the
community. Data were analyzed with an ecological systems model and a number of patterns emerged
within participants’ microsystems, mesosystems, and macrosystems. In the survivor microsystem,
participants’ insecure attachments led to their vulnerability to recruitment; within the mesosystem unsafe
relationships contributed to increased emotional insecurities; in the macrosystem, participants were raised
in environments that desensitized them to prostitution. In regard to escape and resilience, in the survivor
microsystem participants left the sex trade because of pregnancy or mental health symptoms; in this
mesosystem, participants needed safe relationships and increased self-worth; at the level of the macro-
system, once participants left the industry they began processing their traumatic experiences through the
mental health system. These data provide unprecedented insights into the psychological effects that the
sex trade has on the individuals involved, shedding light on an unexplored issue that has a profound, yet
furtive presence in the United States.

Keywords: sex trafficking, domestic minor trafficking, human trafficking, sexual trauma

Human trafficking is a form of modern day slavery that cur- around the issue of sex trafficking, there is a significant deficit in
rently enslaves over 20.9 million people worldwide (International information on victims’ psychological experiences, likely because
Labour Organization [ILO], 2012). Defined by the United Nations of the covert and heinous nature of sex trafficking (Muftić & Finn,
(2000) as the recruitment, harboring, and transportation of humans 2013). As most of what we currently know about sex trafficking is
with force or threats for exploitation, human trafficking became a derived solely from the international realm of the industry, there
focal point for the U.S. government in the late 1990s, with official are virtually no scientific data detailing the processes by which
laws coming online to protect trafficking victims in 2000 (i.e., American women and children are sold into slavery within our
Trafficking Victims Protection Act; Goździak & MacDonnell, own borders. Without a considerably better understanding and
2007). Sex trafficking, one of many form of human trafficking, awareness of survivors psychological experiences, it nearly impos-
consists of the entrapment of an individual for the purpose of a sible to develop culturally appropriate services for victims (Hom &
commercial sex act or a sex act that occurs in exchange for Woods, 2013).
anything of value (Office on Violence Against Women, 2000). Sex Although most of the literature gives content accounts of sex
trafficking is currently the most rapidly expanding form of global trafficking experiences with little participant follow-up, there
criminal activity (Goździak & MacDonnell, 2007), and 98% of are very few descriptions of survivor’s experiences from a
victims are women and children (ILO, 2012). In the United States clinical perspective (Farr, 2005). The psychological accounts of
alone, an estimated 100,000 American children are victims of sex individuals’ stories of sex trafficking are currently invaluable
trafficking annually (Siskin & Wyler, 2010). Although there is a given the deficit in the literature, as the main focus of data on
heavy emphasis on terms, definitions, statistics, and public policy sex trafficking is policy, ranging from domestic to international
regulations. Such a large gap in research in such a specific area
is detrimental to mental health providers’ attempts to treat and
reintegrate survivors. In addition, aside from the scant literature
This article was published Online First August 18, 2014. on the psychological experiences of adult survivors of sex
Stacy J. Cecchet, Kennedy Krieger Institute & Johns Hopkins University trafficking, more information is needed on how children are
School of Medicine; John Thoburn, Department of Clinical Psychology,
recruited domestically into the sex trade (for a recent review of
Seattle Pacific University.
Stacy J. Cecchet is now at PsychMed International, Seattle, Washington. the street prostitution recruitment process see Clarke, Clarke,
Correspondence concerning this article should be addressed to Stacy J. Roe-Sepowitz, & Fey, 2012), the psychological experiences of
Cecchet, PsychMed International, 2116 N. 117th Street, Seattle, WA children who have been victimized, or how many of these
98133. E-mail: Dr.StacyCecchet@gmail.com children are able to survive into adulthood.

482
 DOMESTIC SEX TRAFFICKING 483

The purpose of this research study was to better understand factors all playing a part in its promulgation (LaFromboise, Hoyt,
factors comprising the resiliency of young women who have Oliver, & Whitbeck, 2006). Resiliency is arguably the most im-
survived the sex trade within the United States. Through narrative portant psychological phenomena occurring in childhood; without
interviews, this project tells the psychological story of women’s it many children would struggle to make it into adulthood with the
experiences when sold into the sex trade as adolescents and the chronic adversity they encounter on a daily basis.
various methods of coping they utilized. Factors of resiliency look
fundamentally different for people traumatized from sex traffick-
ing than from other sexual traumas because of the chronic nature Theoretical Orientation
of experiences such as torture, rape, assault, and forced abortion Looking at sex trafficking from a global perspective, the two
(Farley & Kelly, 2000). The following sections review the salient main theoretical orientations that emerge from literature on sex
literature on human sex trafficking and delineate the parameters of trafficking are socioeconomic theory and feminist theory. The
the issue with a specific focus on sex trafficking in the United following section reviews sex trafficking from both theoretical
States. The theoretical orientations that are shaping the dialogue approaches and suggests a context for a new clinical perspective:
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around sex trafficking will also be explored, as they are derived

ecological systems theory. Although the influence of socioeco-
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from the literature on the subject. In congruence with international

nomic theory and feminist theory on understanding the global
and national mandates such as the United Nations General Assem-
market in sex trafficking is prevalent in the literature, theory is
bly’s (1989) Convention on the Rights of the Child and the U.S.
never discussed directly, nor it is applied to any population other
Department of Health and Human Services’ (2010) Child Abuse
than adult women sold into the sex trade. For example, socioeco-
Prevention and Treatment Act, this project defines a child as any
nomic theory influences the literature on the sex trafficking of
person under the age of 18 years.
adults because it purports that there is an underlying relationship
between social standing and economic activity (Becker, 1974).
Child Sex Trafficking: Child Prostitution This is illustrated by the fact that every country’s role in the sex
trafficking industry is directly related to local and global economic
Although current statistics estimate that there are 300,000 pros-
environments, the country’s poverty and employment rates, level
tituted children in the United States (Children of the Night, 2006),
of human development, and per capita income (Farr, 2005). Thus,
there is scant literature addressing their experiences. Although
countries that are typically in the exporting role, trafficking women
there is a paucity of literature on child sex trafficking, existing
resources report that children of the sex trade are subjected to the and children out of the country, are more likely to be economically
same tortures as trafficked women. The average age of a child unstable than the more affluent destination countries. This affects
entering into prostitution is 13 years of age (Smith, Healy Varda- women particularly, as they are significantly more likely experi-
man, & Snow, 2009). Prostituted children live a life continually ence economic vulnerability due to a deficit in sustainable career
threatened with violence and physical abuse such as burns, broken options and a lack of educational opportunities (Farley & Kelly,
and fractured bones, and forms of torture such as having boiling 2000), which becomes more prevalent in economically unstable
water forced into their mouths (Demetriou, 2002). Rape and sexual countries (Farr, 2005).
assaults are part of daily life and lead to sexually transmitted Closely tied to socioeconomic theory is feminist theory. A
infections, forced abortions, and infertility. Additionally, 30%– central function of feminist theory is to examine the impact of
46% of juveniles involved in prostitution attempt suicide (Adlaf & women’s social and class roles on the economy and the power
Zdanowicz, 1999; Greene & Ringwalt, 1996; Kidd & Kral, 2002; differential that exists between men and women (Frisby, Maguire,
Molnar, Shade, Kral, Booth, & Watters, 1998; Yoder, 1999). & Reid, 2009). Although the United Nations estimates that women
Although no current literature reports how many children success- make up 66% of the world workforce, they only receive 10% of the
fully escape or exit the sex trade, these children are reported to world’s income and own 1% of the world’s property (Lorber,
have mortality rates 40 times higher than the national average 2005). On a global level, unemployment and poverty rates are
(Special Committee on Pornography & Prostitution, 1985; see almost always higher for women than men (Farr, 2005), which is
Willis & Levy, 2002, for a specific breakdown of adverse effects compounded by the fact that when women are able to obtain
of prostituted children; Potterat et al., 2004 reports that women employment, they are forced to work for significantly lower wages
involved in prostitution have mortality rates 200 times higher than and in poorer working conditions than their male counterparts
the national average) and are 18 times more likely to be murdered (United Nations General Assembly, 1989). Regardless of the coun-
than their nontrafficked counterparts (Potterat et al., 2004). try of origin, women almost always have a lower status, less
The trauma that a child experiences from being forced into economic opportunity, and less power and are less desirable than
prostitution and sex trafficking is significantly likely to cause men in the workforce and community, which makes them an easy
death, yet somehow some of these children are able to survive into target for human traffickers (Farr, 2005). In the United States
adulthood and reintegrate back into the community. What is it that women earn on average 77 cents for every dollar earned by men
allows them to do this? The most current and widely accepted (American Association of University Women, 2013). In addition,
definition of resiliency is as a multifaceted adaptational process in low socioeconomic neighborhoods are exposed to a disproportion-
which underlying protective processes, as opposed to protective ate amount of legal prostitution (i.e., strip clubs and pornography
factors, aid children in achieving and maintaining their resilience stores), which creates an environment where female children,
(Luthar, Cicchetti, & Becker, 2000). The difficulty with defining adolescents, and women are not only harassed by pimps and johns
resilience stems from the fact that resiliency can also be concep- on a daily basis, but are also actively recruited into the sex trade
tualized on a systemic level: individual, familial, and community (Farley & Kelly, 2000).
 484 CECCHET AND THOBURN

Among this cultural milieu are the cross-cultural issues of to the survival of children and adolescents trafficked. Combin-
gender and racism. Gender is a dynamic issue in sex trafficking; ing systems theory with the extraction and examination of data
it has to do with the individual factor of sex, but also with how from victims’ experiences parses out factors associated with
women are treated culturally and how women cope with cultural survivors’ resiliency and provides an unprecedented look into
adaptation issues (Mayes-Buckley, 2012). When paired with the psychological experiences of survivors (Bronfenbrenner,
racism, gender offers a comprehensive picture of cultural fac- 1986).
tors that influence victimization and conversely resilience in
women who have been involved in sex trade. The issue of
Method
racism is itself complex, especially with regard to African
Americans, who comprise the majority of the current study. The Qualitative research offers a spectrum of designs from which to
African American family was systematically exposed to famil- collect and analyze data (Creswell, Hanson, Clark, & Morales,
ial fragmentation and destruction during the time of slavery in 2007). Narrative research is one particular form of qualitative
America (Hill, 2009). The effects of the destruction of the research and is typically used when the researcher is seeking to
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African American family remain to this day, evidenced by the obtain a spoken or written account of an event or series of events
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low percentage of dual parent families (Hill, 2009), high crime in chronological order from participants (Czarniawska-Joerges,
rates for African American men (Roberts, 2004), higher than 2004). In narrative analysis, data are seen as a narration of actions,
the national average illicit drug use among African American influences, causes, and outcomes and are analyzed by creating a
women (Stevens-Watkins, Perry, Harp, & Oser, 2012) and out temporally cohesive synthesis of the core elements of the story
of wedlock teenage pregnancy for girls (Wright, 1999) and is (Polkinghorne, 2005). This project utilized a narrative analysis
reported by participants as a factor of their vulnerability to approach because of its ability to accurately communicate the
recruitment into the sex trade. These findings are congruent participants’ stories and provide a cultural understanding of the
with the literature, as many researchers argue that the historical experience of surviving child sex trafficking. Gaining a cultural
elements outlined above put African America women at a understanding is an important aspect of this study as it allows the
significantly higher risk for forced prostitution, victimization, researchers to comprehend how an individual’s developmental,
and criminalization than their Caucasian counterparts (Carter, familial, and socioeconomic background influences one’s vulner-
2004; Nelson, 1993; Valandra, 2007). Interestingly, in regard to ability to recruitment into the sex trade and the development of
the African American culture and several familial factors high- personality traits associated with resiliency. Although quantitative
lighted above, Stevenson and Renard (1993) have suggested the research provides a broad statistical overview of factors related to
concept of racial socialization as a means of transmitting cul- an issue, qualitative research provides a depth of analysis through
tural awareness, pride, and values from one generation to the a multilayered approach to data acquisition (Gilgun, 2009).
next. For example, various contextual elements including psy-
chosocial resources (i.e., extended family households and
Participants
church) and engagement in cultural practices may afford Afri-
can American women with some protection against the detri- Currently, there is no standard sample size recommended for
mental effects of racism (Stevens-Watkins et al., 2012). narrative research. However, a number of researchers have sug-
Although these perspectives are important in conceptualizing gested at least two individuals are necessary for thorough data
the scope of the sex trade, direct service providers need a gathering (Clandinin & Connelly, 2004; Creswell et al., 2007).
theoretical orientation that enables them to understand the di- Because of the disproportionately large number of women in-
rect psychological impact on victims and the unique cultural volved in the sex trafficking industry (Farley & Kelly, 2000), only
factors that contribute to their resiliency and survival from such female participants were considered for participation. Participants
horrific circumstances (Hardy, Compton, & McPhatter, 2013). were selected from several sources, such as various local agencies
The lack of systemic care for survivors is multifaceted; service that provide support services to survivors of sex trafficking and
providers typically have a poor understanding of human traf- prostitution as well as members of the Seattle Police Department
ficking, misidentify survivors, lack competency in minimum dedicated to supporting former prostitutes. These sources informed
standards of care for survivors (i.e., stereotyping, criminaliza- its survivor clients of the study, and those interested in participat-
tion, and marginalization victims), and fail to provide systemic ing contacted the researcher to schedule an interview. As such, six
care such as housing, vocational support, trauma-focused ther- female participants over the age of 18 years were recruited and
apy, addiction treatment, and comprehensive medical care (Far- were interviewed until data reached the saturation point and no
ley & Kelly, 2000; Hardy et al., 2013; Hom & Woods, 2013). new information could be obtained from interviews (Creswell,
This gap in the literature warrants the use of a new perspective 1998; Creswell et al., 2007). Data saturation occurs when research-
to bring greater cultural awareness and holistic understanding ers are no longer gaining new information in the form of themes,
of the psychological experiences of survivors of child sex categories, or concepts from participant interviews. Participants
trafficking. Perhaps the best way to view the multiplicity of were stakeholders in this project in that they had been victims of
factors that pertain to sex trafficking is through the lens of the child sex trafficking in the form of prostitution prior to the age of
embeddedness of contexts, with systems that include the indi- 18 years. Individuals who chose to participate in this project were
vidual, family, and culture in a diverse and complex matrix of asked to ask other women they knew who met criteria for partic-
nested relationships (i.e., systems theory; Szapocznik & Kur- ipation if they would be interested in participating in the project.
tines, 1993). The systems psychology approach focuses on This method of generating a larger sampling pool is referred to as
intrapersonal, interpersonal, and environmental factors relevant purposeful selection using snowball sampling and is recommended
 DOMESTIC SEX TRAFFICKING 485

for narrative research (Polkinghorne, 2005). Prospective partici- Review of Data Analysis
pants currently engaged in the sex trade were excluded.
Although there are a number of methods used to analyze nar-
ratives (Hiles & Cermak, 2008), Kelly and Howie’s (2007) rec-
Procedure ommendations for conducting a narrative analysis were used. Data
were analyzed in the following steps: (a) becoming connected with
All interviews were conducted by the primary investigator in a
the participant’s story, (b) attention was paid to Dollard’s criteria
designated secure, private office and lasted no more than 2 hr.
for life history (Dollard, 1949), (c) events and experiences were
Because researcher–participant collaboration occurred throughout
ordered chronologically, (d) core stories were created, (e) plots and
this project, participants were encouraged to contact the researcher
subplots were examined to identify themes that disclosed their
with any questions, comments, or additional information that they
significance, (f) plot structure was examined, and (g) whole nar-
would like to provide. The interview followed a semistructured
ratives were emplotted (p. 141). All six audiorecorded interviews
format. Participants were first asked demographic information
were listened to twice, the first time for transcription and the
(i.e., age, ethnicity, highest level of education, marital status,
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second time to verify the accuracy of the transcription as well as to

parental marital status, and current vocation) and were then asked
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questions focused on personal histories, recruitment into the sex reconnect the researcher to the interview by listening to the audio
trade, experiences as a prostituted woman, the process of exiting recording at the same time as reading the corresponding transcript.
the sex trade, and the psychological effect of surviving domestic In conducting these steps, both researchers reread the transcripts
sex trafficking. The rationale for the demographic questions was to while being mindful of Dollard’s criteria (Dollard, 1949). Specif-
determine if the average age of participants entering the sex trade ically, researchers analyzed data in accordance with Polking-
was congruent with what the literature is currently reporting and to horne’s (1995) seven stages for analyzing a participants life history
attempt to ascertain any other potential patterns among survivors (adapted from Dollard, 1949): (a) contextual features such as
of child sex trafficking. Participants were also able to volunteer cultural context, values, social rules, and meaning systems; (b) the
any additional information that they felt was important at any time embodied nature of the participant including factors that influ-
during the interview process or through personal communication enced personal goals and life concerns; (c) the influence of sig-
thereafter. nificant people in the participants life on his or her actions or
goals; (d) the choices and outcomes of the participant throughout
his or her story; (e) the historical continuity of the participant in
Results light of all of all other participant’s interviews; (f) a temporal
organization that allowed for a beginning, middle, and an end; and
(g) the formation of a story that configured data elements into a
Demographic Information
meaningful explanation of the participants actions and choices. In
All six participants endorsed being United States citizens, spoke accordance with this process, researchers highlighted content in
English as a first language, and were interviewed in the state of the transcripts that was specifically related to the impact of sys-
Washington between March 2011 and May 2011. All participants temic features such as intrapersonal, interpersonal, and contextual
were female and age ranged from 22 to 55 years (M ⫽ 45.5); four meaning in systems, as well as cultural values and norms.
participants identified as African American, one participant iden- Using a cross-referencing system, the number of criteria met
tified as Caucasian, and one participant identified as Mixed. Al- was noted in the margin of the transcript, as well as a brief
though participants represent a wide age range, the common factor reflection of how the datum element related to the criteria. This
among all of them is that they entered the sex trade as children and allowed the researchers to gain a better conceptualization of
survived into adulthood. All participants endorsed being involved how each datum element was included in the participant’s
in the sex trade in the form of prostitution prior to the age of 18 narrative. Narratives were checked for temporal orientation
years. Although all participants endorsed being forced into pros- (i.e., having a beginning, middle, and an end) and reorganized
titution on the streets, four participants reported also working as if necessary.
dancers at strip clubs, two reported also working as an escort, and The next step in data analysis was the examination of plots
one reported additional work on the Internet. Table 1 provides and subplots to identify a theme that disclosed significance.
participant demographics. Plot structure was then examined, where each transcript was

Table 1
Participant Demographic Information

Participant Highest level of Age entered sex Age exited sex Total years in
code Gender Ethnicity Age education trade trade sex trade

A Female Mixed 37 BA 17 29 12
B Female African American 55 MA 16 29 13
C Female African American 22 12th 16 22 6
D Female African American 51 12th 15 22 7
E Female African American 55 Some college 17 22 5
F Female White 40 Some college 16 19 3
 486 CECCHET AND THOBURN

Table 2
Themes, Categories, and Concepts Identified During Data Analysis

Themes Categories Concepts

Sexual abuse Child abuse Predisposing vulnerability

Absent father Child abuse Predisposing vulnerability
Desire to feel loved Vulnerability to recruitment Recruitment
In love with Pimp
Family member involved with prostitution
Prostitution in neighborhood
Belief that violence is love Pimps Threat to life
Violence
Controlling behavior
Johns
Attempted murder
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Rape
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Kidnapping
Atypical sex acts
Substance abuse
Alcoholism
Street drugs
Lack of trust in others Guarded behavior and mistrust in others Systemic isolation
No mental health treatment
Poor family support Lack of support system
Poor interpersonal relationships
Children with pimps or drug dealers Pregnancy Motivation to exit sex trade
Abortion Mental health problems
Severe trauma symptoms
Feelings of numbness Change in lifestyle
Spirituality
Desire to live Resilient personality
Positive thinking
Motivation for change Resiliency

reviewed to identify all plot aspects including cause and effect abuse and absent father. In congruence with current literature (see
outcomes that influenced the story’s ending (Polkinghorne, Farley, 2013), every survivor who participated in this project reported
1995). Researchers were left with themes that were extracted experiencing sexual abuse as a child, having an absent father or both.
from the data, which were then grouped together into broader Participant C described molestation by two individuals, and Partici-
categories. These categories were then grouped together into pant D reported being raped at age 13 years by her sister’s pimp.
broader concepts, representing overall similarities in all of the Participant F also described molestation by two family members, as
interviews. The themes, categories, and concepts were listed in well as being exposed to pornography at a young age:
spreadsheet form; overall, 27 themes were drawn from the data
and were synthesized into 11 categories, and six overarching My dad had a sexual addiction. He was really into porn . . . . My uncle
concepts. See Table 2 for the themes, categories, and concepts is pretty much a known molester in the family . . . . He was slowly
present in the narratives. grooming me. He was getting me to come downstairs and getting me to
touch him and stuff like that. And I was strong enough, somehow I had
strength in me to say “if you ever take me down here again I’m telling my
Conceptual Development aunt.” I think my brother and his experimentation . . . he tried to mess
In the following section each concept and its corresponding cate- around with me. We never fully engaged in sex, but I think that if I wasn’t
a virgin he could have . . . . I was maybe nine years old, and he was in
gories and themes are reviewed in detail. Themes are discussed first
his teen years. I think the things he was thinking about, he was trying to
and their synthesis into categories, followed by the categorical group-
do with me.
ing into concepts. Archetypal passages of the narratives are used to
illustrate and enrich the process of extracting the themes, categories, Ultimately, these early childhood experiences created an
and concepts from the data. Although quotes used in this section underlying vulnerability to engaging in unhealthy sexual rela-
received minor edits for readability and verification of de- tionships. In addition to participants’ accounts of sexual abuse
identification, the essence of each quote was preserved. Additionally, as children, every participant reported either a physical or
it should be noted that transcriptions were not sanitized for the sake of emotional lack of a father figure in her life. Although Partici-
spelling or grammar (i.e., slang terms were not modified). pant A described how her father showed no positive emotional
Predisposing vulnerability. Throughout their narratives, all the connection to her, Participant B talked about the passive neglect
participants described various factors or influences on their life as a that she experienced in her family of origin:
child that made them more vulnerable than their nontrafficked coun-
terparts in the community. The concept predisposing vulnerability is I was raised in a family of 14 . . . . My father was never there . . . . And
comprised of the category child abuse and its two themes, sexual being raised in that environment, you really didn’t have all your needs
 DOMESTIC SEX TRAFFICKING 487

meet. I remember [my pimp] bought me a leather coat. [He] was the first All participants described a deeply rooted desire to be loved that
person who ever bought me something like that, so that was one way for likely stemmed from their childhood experiences of sexual abuse
me to really trust and believe in him. I lost my virginity to him. All these and an absent father figure. Participants reported that, ultimately,
things happened with him, and I think that was the trigger. It wasn’t that it was this desire that their recruiters preyed upon the most,
I had a bad mother, but I think it was because I had a missing link, which connecting these women to their recruiters by a feigned intimacy
was a father and an understanding of relationships. I think that’s where I
or affection.
ended up with him, that’s how [my pimp and I] got involved.
Threat to life. The concept threat to life was one of the first
Recruitment. The recruitment process and vulnerability to to be drawn from the data. Although this concept is comprised of
recruitment was one of the most talked about concepts with the categories pimps, johns, substance abuse, and their correspond-
participants as it is so strongly connected to early childhood ing themes, participants also directly referenced the continuous
experiences as well as their deep longing for love and acceptance. threat to life that is present in the sex trade. Participant A talked
This concept is constructed of the category vulnerability to recruit- about how violent her pimp was and how deliberate his actions
ment and four themes: a desire to feel loved, being in love with the were toward the women that he pimped. She reported:
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pimp, family member being involved in prostitution, and prostitu- He would punish me. I would get slapped almost everyday for
tion in the neighborhood. Examining data regarding participant’s something . . . . My name was “bitch.” He would beat me up really
experiences with being recruited into the sex trade revealed a bad. Or hit me with a pimp stick. It’s a wire hanger knotted up, and
significant relationship between participants’ predisposing vulner- then they beat you with that. I had welts and bruises on my backside
abilities to engaging in unsafe sexual relationships, their vulnera- all the time . . . . He did a lot of humiliating us. He would make us take
bility to being lured into the sex trade, and their ultimately suc- off all of our clothes and just sit there and then he would beat us up
in front of everyone.
cessful recruitment into prostitution. Participant A stated:

I grew up in a house . . . abusive, and my father was an alcoholic. It Participant E added depth to this theme when she addressed
was just a really bad place to be. I started running away and I got other women whom she has known who were killed. She stated:
pregnant when I was 15. My dad told me I couldn’t live at home
I have a cousin that was killed by pimps, and at that Time I was
anymore . . . . Then I met this guy . . . [He was] particularly interested
probably 15, she had to be 16. They found her body cut up in a bag
in me, askin’ me questions and appeared to be worried about me
in Seward Park. One other girl, we were in high school at that time,
and my situation. Sayin’ how beautiful I was, and how ‘this and
they found her killed by some pimps.
that’, and how he was gonna make everything okay . . . . He has
this nice car and nice jewelry, nice clothes, nice everything. I was Johns, the second category, is comprised of the themes at-
kind of into him, and he turned out to be a pimp, and . . . that’s how tempted murder, rape, kidnapping, and atypical sex acts. This
I got involved. I was still looking for that approval from somebody. theme is category perhaps the most emotionally disturbing in this
I loved him and he was like a boyfriend, but he was also like a
section. Although Quinet (2011) reports that female prostitutes are
father. I still love him. I always stick up for him, even today when
likely the number one targets for serial killers, the gravity of this
people talk about him, I always stick up for him.
statistic is difficult to grasp. Although analyzing the data, the
Other participants expanded on this sentiment. Participant B themes attempted murder and kidnapping were quite difficult to
said, separate, as a number of kidnapping stories that participants re-
ported contained an element of a john’s attempted murder. Partic-
A lot of us have low self-worth and low self-esteem. We were just ipant A described her personal experience with having a john try
looking for love, everybody wants love. I think if you don’t under- to murder her:
stand what love is, you look for it in the wrong places, and men know
that. I had one experience with a [john] who stabbed me with a stun gun in
my neck, and then all over . . . . He tried to strangle me and he was
Participant D added to this theme with her description of the telling me he was going to kill me. He hit me with a baseball bat, tore
recruitment process: my clothes, some of my nails came all the way off. My hair was pulled
out. He finally stopped . . . . He started driving and then I jumped out
You’re seduced, [pimps] prey on your weakness, a child’s weakness of the car. Some guy helped me, and the paramedics were asking me
that’s been abused. A lot of society’s stigmatized women and boys, what kind of drugs I took. They didn’t care who the guy was at all. I
they get involved in prostitution. The root of it is some type of abuse, don’t even think there was even a police report made. I’ve had lots of
some type of neglect. The evil seed has been planted whether verbally, guys try to kill me.
or molestation, you know, seeking love. I was seeking validation, I
had been raped, I had been raped mentally first . . . . I have been raped Participant D’s story of when she was kidnapped illustrates the
every which way there is. essence of this category perfectly:

Participant F added to this theme: I got in the car and told him just go around the corner, but he ignored
me. I went to reach for the door, and he reached back and pulled out
I met this guy one day; he was driving a Rolls Royce. I ended up going a nickel plated 45 and put it to my head. He ended up taking me way
with him and he dropped me off at his brother’s house in San Diego. out somewhere, but he knew where he was going . . . he said “hmm,
From all the drugs I was around, and all the hurt, I just ended up in the I haven’t been out here in a long time.” I was 19. He made me strip
worst, worst position. He changed my identity. I had a new birth and put my feet on the dashboard and grab my toes and sit like that
certificate, a different name. with a gun to my head. Then he made me get out of the car, naked [. . . .]
 488 CECCHET AND THOBURN

[H]e had the gun to my head, and he made me perform oral sex. I dealer, or both. In addition, every participant reported that getting
vomited. I just wanted to live, let me live. pregnant was the main catalyst for her decision to leave the sex
trade. Participants described how their motivation to leave was
Participant F reported being slashed with a knife multiple times
driven by a number of factors ranging from a desperate desire to
by a john while he tried to rape her, and Participant B described
keep the baby— because many women reported that their pimps
being held down, injected with heroin, and raped by two johns the
took custody of their children—to a desire to provide a better life
first time that she was prostituted. All participants described en-
for the baby, to a refusal to have another abortion. Participant C
gaging in substance abuse, often as a form of numbing themselves
described how her motivation to exit the sex trade was that she
from the traumatic experiences involved in the sex trade and
wanted to keep her child, because her daughter was in the custody
prostitution specifically.
of her father, a pimp:
Systemic isolation. Viewing these data through systems the-
ory highlights a significant amount of separation from family and I am tryin’ to change my life around. I am getting ready to have
interpersonal systems in participants’ lives. Conceptually labeled another baby. And I hope I can keep custody of my child and be able
as systemic isolation, this concept is made up of the categories to raise it. But, I need to change my life. I don’t wanna be in the same
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

guarded behavior and mistrust in others, and lack of support situation that I’ve been in. I have a daughter, she’s almost 4, but I
This document is copyrighted by the American Psychological Association or one of its allied publishers.

system. Experiences told by participants in this concept add sig- don’t have custody of her; her dad does. He’s a pimp.
nificant depth to their life stories by illuminating the systemic
Similar to experiences with becoming pregnant, many women
loneliness, fear, and isolation that is created by living in the sex
talked about how the impact of making the decision to have an
trade. Participant E explained that her mistrust stems from a refusal
abortion affected them so significantly that they decided they
to ever feel vulnerable again, even if it means she can never
needed to exit the sex trade. On average, participants reported
experience a safe, loving relationship:
having more than one abortion; for example, Participant A stated,
[I’m not able] to give myself freely to somebody [. . . .] I’m not letting “I have one son, and I have had three abortions.” Participant C,
anybody touch me like that . . . . And thinking, I want to love who was pregnant at the time of her interview stated, “I was
somebody, but . . . no. It’s gonna hurt or it’s gonna be painful [. . .] pregnant one time before this time, and I had an abortion . . . . But,
after I had the abortion, I was like, ‘I can’t do this anymore.’ ”
Participant A said, “I don’t really trust. I have girlfriends [. . .]
Participant D described how her experience with abortion
some of them know my story, but it doesn’t mean I trust them.
shaped her and her motivation to exit the sex trade. Although this
[I’m] very detached. Took me a long time to be able to even care
quote has been edited because the graphic nature of this experi-
about . . . to understand that people have emotions.” Participant A
ence, the essence of Participant D’s experience is preserved. She
was also the only participant who reported that she had attempted
stated:
to attend therapy. However, her experience reinforced the belief
that she cannot trust others to understand what she went through: I ended up seeing [my old pimp], and I got pregnant by him but I was
still in the life, I was still with [my new pimp]. [My new pimp] found
One time I went and saw a therapist like, “I need help!” Ya know? out about it, so I had my second abortion. And that took a toll on me
Like, what do you do with all this stuff? And I was tellin’ her some because I had a saline abortion. A saline abortion is when you get an
stories and she started crying! I was just like, “This is crazy!” Like, I abortion when you’re 5 months pregnant and they stick the needle in
am not even crying! your sack and they, they inject a saline solution in there and what it
really does is burn up the baby. And the baby was delivered, but [the
Participant E reported similar concerns regarding working with
doctors] were not in the room. So the baby came out, in between my
a mental health professional: legs. The [doctors] weren’t there, they were out of the room at the
[A therapist] sitting across the table from me, she’s not gonna get it, time. [When] the baby came, it was about 5 months, the baby . . . it
she has no understanding. There’s some stuff I’m not gonna say to her was a full, it was a baby . . . I killed a baby.
because it would be probably too grotesque, freak her out. How’s she
Participants reported that these themes in particular involved
really gonna help me?
such distressing experiences that they believed that leaving the sex
Throughout their stories, as participants described their struggle trade was the only way for them, and their children, to survive.
to relate safely with others and their often conscious desire not to The next category in this concept is mental health problems,
pursue mental health treatment, it became apparent that these which was derived from the themes severe trauma symptoms and
themes specifically were having a significant effect on partici- feelings of numbness. Every woman who participated in this proj-
pants’ family and social interactions, creating a very systemic ect reported severe mental health problems that were divided into
pattern of isolation. two themes: severe trauma symptoms or feelings of numbness
Motivation to exit the sex trade. This concept is especially (dissociation). The category mental health problems was placed in
noteworthy because without being able to break it down into the the motivation to exit lifestyle concept because all of the symp-
categories pregnancy, mental health problems, change in lifestyle, toms that participants described were able to be directly connected
and their corresponding themes. insight into how survivors are able to their decision to leave the sex trade, as their mental health
to motivate themselves into leaving the sex trade would not be problems made it so they could no longer live that lifestyle.
possible. Perhaps one of the most emotional discussions with Participants reported a number of different trauma symptoms such
participants was centered on the category pregnancy and its two as depression, anxiety, flashbacks, and avoidance. Participant A,
themes: children with pimps or drug dealers and abortion. Every who has worked with a psychiatrist to treat some of her trauma
participant reported that she had a child with either a pimp, a drug symptoms with medication, reported, “I do have PTSD, so I have
 DOMESTIC SEX TRAFFICKING 489

to take medication. I have really bad panic attacks . . . and I have Participant C described her struggle to achieve change and the
depression, so I take medication for that.” Participant E expanded emotional effect it has had on her:
on this idea with her description of being physically sickened by
I’d say, for 9 months I’ve really been tryin’ to change my life, cause
anything that reminded her of her experiences in the sex trade:
nobody wants to do that forever. I’ve racked up a lot of charges,
I just remember, it was probably the most sickening experience. I was maybe 7. I really wanna change. I wanna go to school. I want to go
emotionally . . . it was becoming too much. I was tired of condoms, back to the goals that I did have, when I was in school. I just wish that
the smells, the people touching me, you know, by the time I exited I didn’t go into that lifestyle. I had other things that I could have done.
out I was probably 22ish or something. But I was just tired of And now it’s like, I’m still young—I’m 22— but it’s hard. I just made
people touching me, I was just tired. Emotionally, I was getting to it harder on myself [crying]. And now I have to . . . I’m tryin.’ That’s
all it takes, is to try. But, it’s just hard.
the place where I couldn’t manage things anymore. The smells, the
touches . . . .
Participant E talked about how, though she was able to achieve
In addition to severe trauma symptoms, all participants reported change and leave the sex trade, she struggled for many years with
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experiencing severe numbness and detachment from their feelings forgiving herself and learning acceptance:
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and interactions with others. For example, Participant A made a Thirty years I’ve been out of that lifestyle, and it still took me a long
comment about detachment when she talked about what it was like time to forgive myself for being in it. A long time to feel clean again,
to participate in this project. She stated, “I’m still detached from it. because some of the stuff that you do when you’re involved in that
I can’t really feel it when I’m talking about it. I can’t feel it. Like, lifestyle . . . . A long time to not compare myself to other people, not
I don’t want to cry or anything like that.” Participant D explained worry about what other people were saying.
that becoming numb to her feelings was a way for her to survive:
Regardless of any other themes or categories at play in the data,
It’s a process, and then if a person hasn’t had counseling in that area, the themes that have emerged here are the single most important
like a lot of us didn’t, we learned to suppress [our feelings]. It creates factors in explaining how and why these participants were able to
a problem. I had to mentally separate, you really just become like a survive the sex trade when many of their sex trafficked counter-
machine. It’s business. You just learn how to shut it off [. . .]. A lot parts are not as fortunate.
of numbing. Even if you come out alive it’s a lot of numbing.

The last category, change in lifestyle, was created and sustained Discussion
by the theme spirituality, which participants also reported is still
present in their lives. Many women in the sex trade have reported Sex trafficking is the third largest (Miko, 2002) and the fastest
that they looked to a higher power for support (Oselin & Blasyak, growing form of global criminal activity (Goździak & MacDon-
nell, 2007). Though sex trafficking is characterized by extreme
2013). Similarly, participants reported that by changing how they
violence (Demleitner, 2001), the United States remains the second
viewed the world and recognizing their spirituality, they were able
largest consumer in the world (Mizus, Moody, Privado, & Doug-
gain the courage to take steps to change their lifestyle and ulti-
las, 2003). In an effort to decrease the paucity of information and
mately leave the sex industry.
awareness of survivor’s experiences, this project analyzed the
Resiliency. The entirety of this project was predicated on the
narratives of six survivors of child sex trafficking to assess factors
emergence of this last concept, resiliency, the category resilient
that influenced their ability to survive, leave the sex trade, and
personality, and its corresponding themes desire to live, positive
reintegrate back into the community. The system of sex trafficking
thinking, and motivation for change. While examining the data in
in the United States that has emerged from this study is based on
this category, it became apparent that the women interviewed the pimp–prostitute–john system, which appears to be qualitatively
for this project have naturally resilient personalities, as evidenced different from the system of organized crime that occurs in the
by the themes present here: desire to live, positive thinking, and international sex trade (i.e., false promises of jobs, kidnapping, and
motivation for change. No matter what trauma or injustice they parents selling their children to traffickers). Domestic sex traffick-
suffered, they were able to persevere and not only maintain the will ing is organized around interpersonal and romantic violence be-
to survive but also the strength to guarantee their survival. Partic- tween pimps and prostitutes that is then mirrored in the prostitute–
ipant D talked about the growth that she has experienced while john relationship.
reflecting back on her life, “We’re victims. We were victims In light of the deficits in current theoretical orientations in the
should I say, even if we victimized ourselves. But we are survi- literature, discussion of the data and the results of this project were
vors, and we’re overcomers. It’s one thing to survive, it’s another framed within an ecosystemic model. This model suggests that
to overcome.” Participant F reported that she has been able to learn there are three environmental levels of functioning in an individual
from her experiences and become stronger: or family’s life (Bronfenbrenner, 1986): the micro, meso, and
macro systems. Within the microsystem, it is apparent that all of
I’m more grateful for my life because of what I was able to go
the women in the project struggled with establishing safe and
through, and come back. I think I did some of my own healing and
acceptance of things. [. . . .] You have to kind of let go of those things secure attachments in childhood, in lieu of sexual abuse and an
that have been holding you back and forgive people, and forgive absent father. These early childhood experiences created feelings
yourself. That was the biggest thing for me, forgiving myself for the of being unloved or uncared for and ultimately led these women to
things I did. I carried so much shame and guilt in that part of me that being more vulnerable to becoming involved in the sex trade.
I couldn’t tell people. Finally was just like, you know what? I’m doing These patterns of having insecure attachments within their families
fine. I’m perfectly fine and wanting a healthier relationship. and participants’ negative feelings about themselves were then
 490 CECCHET AND THOBURN

replicated in the relationship that participants had with their pimps tionships, as well as the importance of making interpersonal
and others in the sex trade. Participants believed that in order to be connections outside of the sex trade. Participants reported that
loved they must allow themselves to be subjected to daily violence, they were often isolated from family, friends, and even their
as well as emotional, physical, and sexual abuse. peers within the sex trade. In addition, the few interpersonal
Within the mesosystem, participants’ interpersonal relationships relationships that participants did have in the sex trade involved
throughout their lives led to feelings of pain and betrayal. These constant threats of violence, betrayal, and sexual assault. Feel-
women experienced significant trauma in their interpersonal fa- ings of fear and isolation became overwhelming and as such
milial relationships such as rape, abuse, and incest. These trau- participants began considering the importance of new support-
matic experiences were then maintained when they were recruited ive, safe, and healthy interpersonal relationships. These new
into the sex trade through the rape and violence that they experi- relationships held the possibility of forming new more secure
enced from johns and from their pimps. This pattern of trauma attachments, learning affect regulation skills, building auton-
within the system of interpersonal relationships led to participants omy, and processing trauma.
developing mental health problems such as depression, anxiety, Lastly, participants reported experiencing changes within the
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

and posttraumatic stress disorder. macrosystem. Once participants left the sex trade, they began
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Participants’ experiences within the macrosystem significantly the process of establishing a life outside of the industry’s
influenced how they viewed the world; participants grew up in a culture of fear and powerlessness, with different social and
culture where prostitution was normalized, where friends, acquain- emotional supports. This gave participants emotional room to
tances, and even siblings were involved in prostitution. Partici- work on increasing their resiliency through their desire to live,
pants believed that prostitution was normal and were desensitized develop positive thinking, and foster ongoing motivation for
to the possible life experiences that the sex trade mandated, mak- change. The new environment that participants were living in
ing participants more vulnerable to recruitment. Once participants allowed them the opportunity to talk about their experiences
were recruited into the sex trade, they were immediately immersed with new support systems, such as family, church groups, and
in a culture of fear where women were considered property. advocacy organizations, and to begin working to process their
Participants became trapped in a culture where they had no power traumatic experiences.
and were subjected to constant violence, rape, and the threat of In an effort to further elucidate participants’ resilient person-
death. This environment led to feelings of helplessness and numb- alities, it is important to look at how these women have not only
ness, which contributed to participants continued engagement in survived, but have demonstrated their incredible strength. At
risky behaviors and substance abuse. the time of the interview, Participant A had recently married her
Examining these three systems within the context of escape and husband and was in a healthy, loving, happy relationship. She
resilience, additional patterns emerge across participant interview currently works at a nonprofit organization dedicated to helping
data. Within this microsystem, participants often became moti- youth living on the streets and those who are involved in
vated to exit the sex trade as a result of pregnancy or from a desire prostitution. In addition, she regularly volunteers with a local
to ameliorate mental health symptoms. Many participants reported police department and other advocacy groups to provide train-
that multiple pregnancies and abortions caused significant distress ings and support for men and women involved in prostitution.
and ultimately led to them making the decision to leave the sex Participant B left the sex trade and went on to earn her Masters
trade in an effort to keep their children. In addition, participants Degree from a reputable local university. She is currently the
reported that the level of mental health symptoms they were Director of Outreach Services at a nonprofit where she works
experiencing such as depression, anxiety, and posttraumatic stress with youth both living on the streets and those involved in
disorder became too much to bear. These experiences also influ- prostitution. She is also actively involved with her church,
enced women’s intrapersonal perception of themselves, changing youth ministry, and community advocacy efforts.
how they thought and felt about being prostituted and creating a At the time of the interview, Participant C was pregnant and
desire for change. had only been out of the sex trade for 1 week. She tearfully
Viewing the mesosystem through the lens of escape and expressed a strong desire to go back to school and raise her
resilience, within their interpersonal relationships, participants baby in a safe, healthy environment. Participant D is in a
reported recognizing the need for meaningful and healthy rela- fulfilling marriage and spoke at length about how her work as

Table 3
Concrete Indices of Survival

Participant Number of
code Marital status children Employment Community participation

A Married 1 Advocate at a nonprofit Advocate for youth involved in prostitution

B Married 1 Directory of outreach services at a nonprofit Advocate for youth involved in prostitution;
ministry
C Single 2 Unemployed None
D Married 1 Life coach Minister; motivational speaker
E Divorced 2 Case manager at a nonprofit Advocate for youth involved in prostitution;
church involvement
F Single 1 Legal assistant Church involvement; advocate
 DOMESTIC SEX TRAFFICKING 491

a motivational speaker, minister, and life coach has helped her Future Research
to not only help others heal, but to heal herself as well. She also
works closely with her community and church though her It is clear that future research is needed to gain a more in-depth
volunteer work helping other women and children involved understanding of the psychological experience of survivors and
with prostitution. Participant E is currently employed as a case how to provide them with care. Qualitative research is suggested as
manager for a local nonprofit organization and specializes in the first step, or first-order change, in understanding and providing
working with homeless youth and youth involved in prostitu- care to survivors of sex trafficking because the paucity in the
tion. She is dedicated to her church, her work as an advocate, literature regarding this subject prohibits change from occurring.
and her children. Participant F has a stable job as a legal Quantitative data gathering is a natural follow up to qualitative
assistant and is deeply involved with her community. She works research; in fact, using both qualitative and quantitative research to
with her church and other nonprofits to help generate awareness examine such a significant topic is the best way to blend the
about youth in prostitution and loves her son very much. Table gradual understanding of a phenomenon with richness and depth.
3 provides concrete indices of survival.
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Limitations
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Clinical Implications There are several limitations in this study that should be dis-
Findings from this study serve to illustrate significant clinical cussed. The first is that although this project worked with a
implications that are not only extremely relevant to clinicians and representative sample size, it was small in nature and participants
service providers but may serve to inform their interaction with were self-selected. Although a sample of six participants is appro-
and the provision of care for this population. Framing our findings priate for a qualitative study of this kind, in terms of reaching data
from a systems model, within the survivor microsystem it is saturation, it can make it difficult to generalize the results. Future
apparent that women and children exiting the sex trade are not studies should seek to replicate these findings with a larger pop-
getting the personal medical or mental health care (i.e., therapy) ulation of survivors to help lend support to the clinical implications
that they need. This occurs for a number of reasons, for example, and recommendations reported from these findings. The second
responders assisting with escape from the sex trade not knowing limitation is that five of six participants were actively involved
that there is a need for mental health care; responders not knowing with religious organizations connected to the community and
how to connect survivors with services; survivors refusal of mental providing care to survivors, thus possibly making the theme of
health treatment for cultural reasons; and survivors remaining spirituality a limiting factor to this population of women. The third
desperate for culturally competent care but finding that they have limitation is that all participants were survivors of domestic sex
no access to it. trafficking in the form of prostitution, which is a very specific
Examining the survivor mesosystem illustrates a need for family subset of the larger sex trafficking population. It is likely that
counseling services in areas prone to sex trafficking. This became survivors of international sex trafficking would report a number of
apparent through data analysis as participants reported that they very different experiences and themes. The fourth limitation is that
not only grew up in area with high rates of prostitution but were participants ranged significantly in age, as well as their length of
also raised in families with high levels of discord, neglect, and time out of the sex trade. Although current literature supports this
child sexual abuse. Although participants are now adults, the need participant pool because a preponderance of prostituted women
for family systems work is still prevalent as many participants experience chronic and complex posttraumatic stress disorder,
reported that either they had never discussed their experiences with problems with addiction, depression, and anxiety, gathering addi-
their families or that they felt a deep sense of betrayal from tional data on the psychological experiences of younger women
families who knew they were involved in the sex trade, but made who have more recently exited the sex trade will be paramount in
no effort to help or protect them. continuing to develop culturally relevant and appropriately sensi-
At the level of the macrosystem is the need to increase com- tive treatment recommendations for this population.
munity awareness of sex trafficking. Many people in the United
States either do not know what sex trafficking is, or believe that it
Conclusion
only occurs outside of the country. Until communities are able to
recognize this problem, create more laws, and increase standards The purpose of this project was to gain an in-depth understand-
of care for survivors, we will be unable to mitigate survivor ing of the psychological experience of survivors of child sex
trauma. Generating more awareness about sex trafficking prosti- trafficking, as well as factors that may influence their resilience.
tution as well as increasing the community’s education about This was achieved by utilizing a qualitative research method for
vulnerabilities to recruitment may decrease prostitution and sex retrieval of data, examining traumatic factors, and factors that
trafficking rates. There is a strong need to support survivors’ influence resiliency in adult survivors of child prostitution. This
wellness and reintegration into the community without judgment project revealed a total of 27 themes, 11 categories, and six
and punishment. Additionally, community awareness often leads concepts (predisposing vulnerability, recruitment, threat to life,
to the development of early intervention and prevention programs systemic isolation, motivation to exit the sex trade, and resiliency)
for at risk youth. The development of successful, evidence-based from the data to represent the psychological experiences of six
prevention programs, both for girls and women at risk of sexual survivors of domestic child sex trafficking in the form of prosti-
exploitation and for men at risk of engaging in exploitative behav- tution.
ior (i.e., pimping), would be a significant milestone in decreasing Data were analyzed with an ecosystemic model (Bronfen-
the prevalence of the domestic sex trafficking of minors. brenner, 1986), and a number of patterns emerged. In regard to
 492 CECCHET AND THOBURN

recruitment, participants struggled with developing safe, secure Farley, M., & Kelly, V. (2000). Prostitution: A critical review of the
attachments in their microsystems. Participants dealt with unstable medical and social sciences literature. Women and Criminal Justice, 11,
interpersonal relationships that led to feelings of fear and betrayal, 29 – 64. doi:10.1300/J012v11n04_04
and participants were immersed in an environment where people Farr, K. (2005). Sex trafficking: The global market in women and children.
were desensitized to prostitution and violence. Looking at the data New York, NY: Worth Publishers.
Frisby, W., Maguire, P., & Reid, C. (2009). The ‘f’ word has everything to
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do with it: How feminist theories inform action research. Action Re-
pants’ motivation to leave the sex trade was a result of pregnancy search, 7, 13–29. doi:10.1177/1476750308099595
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