When sociologist Alexandra "Sandi" Pierce, PhD, met a handsome swimming champion her first semester of college, everyone told her he was a great catch. He wasn't. Once she married him, he turned out to be a violent pimp who tortured her.

"We were a golden couple and looked like all-American kids," says Pierce. "But I was a private party girl; he would set me up with wealthy men and obligate me to have sex with them."

That kind of discrepancy between appearance and reality is one factor that makes it hard to know for sure how many women and girls are trafficked in the United States, according to Pierce and other members of APA's Task Force on Trafficking of Women and Girls.

Trafficking — a human rights violation characterized by economic exploitation of people via force, fraud or coercion — is by its very nature clandestine, says Nancy M. Sidun, PsyD, the task force's co-chair and a supervising clinical psychologist for Kaiser Permanente's Hawaii region.

"Even people who are trafficked don't necessarily identify themselves as trafficked," Sidun says.

Plus, trafficking takes many different forms, with both domestic and foreign women and girls being sexually exploited or forced to work in agriculture, domestic servitude, the nail and hair-braiding industries and other venues. "There's also no one picture of who traffics," Sidun adds. "It could be your cousin, a total stranger or organized crime."

These and other challenges have meant that the empirical evidence on how best to prevent trafficking and treat survivors is weak or even missing altogether. A new APA report may change that.

The "Report of the Task Force on Trafficking of Women and Girls" summarizes the scientific literature since 1980 on trafficking, both of women and girls within the United States and those brought to this country. The report aims to raise psychologists' awareness of trafficking, urge them to bring their scientific rigor and research expertise to bear on the problem, and offer recommendations for improving research, treatment and other areas.

"It was surprising how little we actually know and how much there still is to find out," says Deborah L. Hume, PhD, task force co-chair and an associate teaching professional in the master of public health program at the University of Missouri. "There's so much research that needs to be done to address the problem, even in terms of how many people are affected."

Evaluating the anti-trafficking programs sponsored by nongovernmental organizations and other groups is especially important, the task force emphasizes.

"Programs for trafficking survivors are frequently working with minimal resources, so they don't want to spend those limited resources evaluating what they're doing, how they're doing it and whether it's effective or not," says Sidun. "There are incredibly good-intentioned programs out there, but we don't know how effective they are or even how effective the anti-trafficking movement as a whole is."

For example, it's still unknown how effective group therapy is with trafficking survivors. While there is some evidence that it is effective, says Sidun, there is also evidence that suggests it could be counterproductive or even destructive for trafficking survivors.

"With domestic trafficking of adolescents, many times it's a stable of girls pitted against each other," she says. "It's a very competitive, cut-throat environment, so working together collaboratively and respectfully in group therapy may not occur."

The report makes dozens of other recommendations, including:

  • Delineating specific areas where more research is needed. The report calls for interdisciplinary research that recognizes the complexity of trafficking. It also urges researchers to develop and conduct their research in collaboration with trafficking survivors and clinicians with extensive experience in treating this population. In addition to program evaluation, the task force's research priorities included examining risk factors for trafficking, finding ways to reduce demand for commercial sex, exploring the tactics traffickers use to coerce victims and determining trauma's impact on survivors' decision-making and willingness to receive services and cooperate with law enforcement.
  • Developing better screening tools and treatment. Trafficked women and girls can experience potentially life-threatening, lifelong physical and mental consequences, such as anxiety, depression, addiction, post-traumatic stress disorder and traumatic brain injuries. The report calls for the development of more effective screening tools that therapists, social service providers, law enforcement personnel, health-care providers and others can use to identify women and girls who are being trafficked. It also urges professional psychologists to develop partnerships with social workers, law enforcement and victim services networks and to provide evidence-based, culturally competent treatment.
  • Designing training for health service providers and others. To increase knowledge of trafficking within psychology and beyond, the report recommends the development of training curricula for both psychology graduate students and trainees as well as for service providers, health-care professionals, teachers, the business community and policymakers. The report also suggests that APA's Office of Continuing Education in Psychology develop a continuing-education program based on the report's findings.
  • Changing public policy. To promote deeper understanding of trafficking, the report urges psychologists to push for more research funding, promote human rights protections for all workers in the United States and advocate for a review of immigration policy to eliminate abusive labor conditions.
  • Increasing awareness. The report recommends campaigns that increase the public's awareness that human trafficking occurs in all types of communities and includes both labor and sex trafficking. Public education campaigns should also address misperceptions about trafficking victims, educate the public about common signs of human trafficking and educate parents and youth about how to prevent it.

One overarching recommendation is to get more psychologists involved in the fight against trafficking of women and girls, says Sidun.

"No matter what a psychologist does, there is a place within the trafficking world to intervene, whether it's treating survivors, providing expert testimony for legislators or creating materials for a public awareness campaign," she says. "Psychology has so much to offer."

Acknowledging the expertise of trafficking survivors themselves is also key, says Hume.

"Despite the devastation that they've experienced, they are the ones who know what the risk factors are, what techniques were used to lure them in and control them, what's effective in terms of prevention and response," she says. "They've been leaders in anti-trafficking work in this country and around the world, and psychologists need to make sure we recognize that."

For Pierce, serving on the task force was one way to help ensure that other women and girls don't have to go through the kind of ordeal she endured.

"Psychologists need to ask the right questions," says Pierce, who is president and senior consultant at Othayonih Research and Evaluation in St. Paul, Minnesota. "That's my whole purpose in doing this."

Rebecca A. Clay is a journalist in Washington, D.C.