“I Can Relate”: Survivor Leadership Supporting Women Transitioning Out of the Sex Trade

Survivor Leadership Frameworks and Practices

Examples or frameworks of survivor leadership can be found in the literature related to mental health and to exiting the sex trade. O’Hagan (2009) provided a user/survivor leadership framework for mental health services. The framework encompasses survivor leadership at the individual user level (patient), the service provider level (survivor leader), and the institutional level (organization). At all levels, survivors are treated as experts in their own treatment. In addition, the framework positioned survivors as equal to non-survivors and as the most informed about their own needs. O’Hagan contrasted this form of leadership with participation, saying, “Leadership assumes that people with mental health problems have the power to set the agenda, make major decisions and control resources” (p. 35).

In the context of the sex trade, Standing Against Global Exploitation (SAGE) created a model for survivor leadership, with similar tenets to O’Hagan’s (2009) framework. Hotaling, Burris, Johnson, Bird, and Melbye (2003) said SAGE was successful because of the peer education model. The model encourages participants’ independence, promotes healing and freedom from abuse, and relies on participant-driven treatment plans. O’Hagan and SAGE emphasize giving power to participants—a critical topic, which will be discussed in the following section.

Power and Survivor Leadership

An important concept in peer driven models is balancing power between provider and user. O’Hagan (2009) contrasted survivor leadership with conventional leadership in corporate environments. An important difference was survivor leadership’s focus on equality and empowerment, specifically “‘power with’ leadership” (O’Hagan, 2009, p. 38). O’Hagan called for “a psychological shift within users and survivors themselves, from a marginalised disempowered identity to empowered identity” and a shift for mental health professionals from an identity as “expert authorities to expert advisers” (p. 40). In addition, O’Hagan recommended shifting power and resources from non-survivor mental health professionals to share power equally with survivors. O’Hagan claimed a power shift is more likely to occur if survivors have positional power by serving in leadership roles at all levels in the mental health profession.

Hotaling et al. (2003) offered specific insight as to why power imbalance is especially problematic for women exiting the sex trade. Hotaling et al. said, “many women characterize their prostitution as exploitation based on an extreme power difference: men who use disposable income to buy sex acts from women and girls who need the money for survival” (p. 257). Hotaling et al.’s solution to the power imbalance was to provide “client centered intervention methods designed specifically to meet their needs” (p. 259), run by survivors, through a nonjudgmental, harm reduction model.

Power is a well-researched concept in adult education. Power imbalances can interfere with learning by reinforcing the status quo, when existing social structures are not adjusted or when a learner’s marginalization is not disrupted (Merriam, Caffarella, & Baumgartner, 2007). Marginalization may impair an individual’s ability or opportunity to reflect on their learning, which is an important component of the development process (Merriam & Bierema, 2014). Learners can be further marginalized when educators too actively manage learners’ experiences and reflections such as when educators determine what should be considered a significant experience (Michelson, 2015).

Value of Survivor Leaders

Participants valued survivor leaders’ involvement in their transition out of the sex trade. All 10 participants relied on the mentorship provided by other survivors for three reasons—relatability, modeling a hopeful future, and mitigating power issues. The advice and support participants received from other survivors, who shared similar experiences, was critical to their learning and development while transitioning out of the sex trade.

How to Utilize Survivor Leaders

Participants recommended three ways organizations helping women exit the sex trade could engage survivors: on boards, in paid staff positions, and as volunteers. Six of the 10 participants had experience in these roles. Two served as board members, six were volunteers, and three were current or past staff. In addition, some participants conducted trainings or served as key note speakers for law enforcement, churches, the public, and the health care community.

When engaging survivors in these roles, participants emphasized the importance of considering them experts. The participants were experts in the lifestyle because of their experiences. Related to being an expert, Elizabeth referred to being a survivor as a “credential,” which was needed to understand what participants in organizations had experienced. She said, “When you’ve lived that kind of lifestyle . . . it means a lot to have that, credential [emphasis added], or really understand.” However, participants often felt their expertise was overshadowed by being survivors.

Gloria believed most individuals viewed her as a survivor rather than in her role as expert. After exiting, Gloria gained extensive experience working for an organization as an advocate. She became an expert on the federal trafficking laws and completed a degree in public policy with an emphasis on human rights. When she applied for a position at a government agency, the expert/survivor issue came to the fore. Gloria said,

I applied to [a government agency] as an expert and then they were like, “We’re going to run your criminal background.” I said, “Oh, whoa, wait a minute. I forgot to mention, I’m a survivor too.” But I wanted to be deemed as an expert consultant, not a survivor. Because that’s what I am.

The balance between being a survivor and being treated as an expert was further illustrated in how participants’ were valued monetarily. Helena said, “What they’ll find is the executive director’s making a good paycheck, and the business director is making good paycheck, and the accountant is making good paycheck, but you want us [survivors] to volunteer.” Gloria now consults for individuals working as survivor leaders. She coaches survivor leaders and organizations to ensure they are paid a living wage:

Pay survivors a living wage. My whole thing with the survivor leaders is they are like, “Well, the church asked me to do a speaking engagement.” “That’s really great. How much are you getting paid? Do you have a contract with them? What happens if there is a cancelation?”

In the following section, we will discuss these findings in the context of the related literature.

Relatability

Our findings showed the importance of counselors knowing firsthand what users are thinking and feeling as they transition out of the sex trade. Consistent with peer leadership in other contexts (Baumgartner, 2007; Baumgartner & David, 2009; English & Irving, 2015; Pantridge et al., 2016; Preissner, 2013), this study’s participants desired interaction with other survivors who could relate to their experiences. Hotaling et al. (2003) emphasized the trust built through firsthand knowledge survivors have of the overwhelming obstacles, including the shame and social stigma, encountered when exiting the sex trade. Hotaling et al. remarked that the comment, “‘You don’t understand’ disconnects survivor from the non-survivor (or ‘straight’) counselor” (p. 259). These scholars’ comments are consistent with Eva’s ability to build a bridge as a result of her similarities with participants.

Hotaling et al. (2003) also said that when participants receive “support from others who have ‘been there’, they begin to believe they, too, can recover” (p. 262). This concept was evidenced in this study by the hope survivor leaders gave to users, which will be described in the following section.

Hope

In this study, Gloria represented other participants’ experiences when she shared how important it was to know her counselor had been in the same place she was 15 years earlier. Seeing how much progress her counselor had made gave her hope she could progress as well. Participants’ feelings about hope supported a similar claim made by Hotaling et al. (2003) about SAGE:

SAGE counselors serve as role models for clients. Many women who come to SAGE have never made money other than through prostitution. When clients see that others just like themselves have achieved the goals of living independently and outside of the sex industry, they begin to believe they, too, can accomplish this.

Similarly, Harris and Larsen (2007) found hope was an important benefit offered by peer counselors and support for individuals living with HIV. The following section will discuss survivors’ impact on power.

Power

O’Hagan (2009) described power at the individual and service levels. Individual-level leadership involves taking ownership of one’s own mental health recovery. Leadership at the service level involves survivors in institutional leadership, such as leading peer counseling initiatives and management-level positions within organizations. In this discussion, we will focus on service-level leadership, supported by this study and existing literature, as it relates to power within an organization.

As evidenced in the findings, power at the service level can manifest itself in oppressive rules established by the organization. Hotaling et al. (2003) warned against such confrontational practices. The authors said, “Women who come to SAGE have already survived so much traumatization that they cannot tolerate pressure and confrontation” (p. 262). SAGE’s nonjudgmental, harm reduction model provides an alternative model to the structured, possibly oppressive rules offered by other organizations. For example, SAGE does not require participants to abstain from drugs or engaging in the sex trade to receive services.

Alternatively, the organizations included in this study provided very structured rules, including curfews, restrictions around when women could leave and where they could go, what women could say, required suspension of activity in the sex trade, abstinence from drugs, and mandatory church attendance. These findings are consistent with a prostitution rehabilitation program (PRP) studied by Oselin (2009). Oselin called the initial phase when participants enter an organization “clampdown on the rookies,” which is an especially restrictive phase (p. 389). She described the restrictions, which were consistent with rules experienced by participants in this study: “residents cannot leave the premises without a chaperone, cannot have any contact with former friends, and are controlled by a strict schedule of activities including school, therapy, meetings, preparing dinner, chores, and doing homework” (p. 389). The rules relaxed as participants spent more time in the PRP. The rules described by Oselin, and experienced by the participants in this study, are less oppressive than the limitations on the amount of toilet paper women could use, which was described by Gloria in the findings of this study. However, they still provide stringent restrictions on the women’s behaviors, which are not consistent with SAGE’s practices.

O’Hagan (2009) called for a change in philosophical views about mental health problems. The scholar claimed the current view—a “deficits-based view . . . perpetuates inequality and disempowerment, despite its benign intent” (p. 40). A deficits-based view focuses on individuals’ shortcomings and addressing such challenges. Alternatively, a strengths-based view focuses on strengths and strength development (Hiemstra & Van Yperen, 2015). The deficits-based view may provide context for why leaders of organizations helping women exit establish extensive rules to address deficiencies in women’s behavior and manage their activity. In addition, assuming a deficits-based view limits the ability to view survivors as experts in their own rehabilitation and in the rehabilitation of their peers. The literature supporting the findings in this study related to viewing survivors as experts will be discussed in the following section.

Survivors as Experts

The findings in this study support viewing survivors as experts to balance power in organizations helping women transition out of the sex trade. Viewing survivors as experts is an alternative mind-set to the deficits-based view. Survivors have unique expertise and competencies because of their experience in the sex trade, which can make them effective mentors and counselors for other survivors. In this study, Elizabeth called being in the lifestyle a credential. Similarly, Hotaling et al. (2003) said, “In the world of prostitution, survival is a testament to one’s capabilities” (p. 263). Survival of the sex trade and success in transitioning out are testaments to an individual’s expertise and competencies, which would be valuable to share with others attempting to transition out of the sex trade.

Hotaling et al. (2003) provided a tangible example of a skill a survivor would have in peer counseling and education. Specifically, survivor leaders, who were recruited into the sex trade by a person they thought was their boyfriend and later identified as a pimp, could more easily recognize the pattern in other participants. Based on these conclusions, the following section provides practical recommendations for incorporating survivor leaders in organizations helping women transition out of the sex trade.

Practice

Survivor leaders are experts in their experiences in the sex trade, in exiting the sex trade, and in the longer-term process of transitioning out of the sex trade. However, this expertise alone may not be sufficient to ensure success of survivor leadership. O’Hagan (2009) referenced three causes for failure in survivor-led organizations: (1) “the unequal distribution of power and resources, which is reflected in the lack of infrastructure to develop peer-run initiatives”; (2) the failure to support survivors in competency development through “mentoring, tailored training and development, career pathways, standards of practice and so on”; and (3) low participation by survivors who “rely on the goodwill and invitation of others” (p. 35). The findings in this study address points (1) and (3).

Therefore, we recommend organizations engage survivors at all levels. An invitation may be necessary for survivors to feel welcome. Organizations should ask survivors to participate, if power and resources can be distributed equally to survivor and non-survivor leaders. Without equal distribution of power and resources, survivors are likely to burnout and/or fail to meet expectations (O’Hagan, 2009). As Gloria asserted, survivors should be paid a living wage when engaged in staff positions within organizations. Many of the survivors interviewed in this study wanted to give back to the organizations supporting them on a volunteer basis. When survivors choose to engage on a volunteer basis, they should be treated as equals or even with a higher status than non-survivor volunteers, based on their unique expertise. An easy to implement position is that every organization supporting survivors should have survivors on their board. In such a position, survivors are given a vote equal to other board members’ and their perspectives should be equally valued.

The findings in this study did less to address O’Hagan’s (2009) second point, which is a salient issue. As O’Hagan said, “The approach that can gain the quickest and easiest traction is probably increasing user/survivor skills and competence” (p. 39). Like any other mental health or counseling professional, survivors need additional training, mentorship, and clear policies to be effective in organizations. SAGE provided a great example of peer educator training through higher education, mentorship, and specialized training in substance abuse, trauma support, and domestic violence (Hotaling et al., 2003, p. 263). These are skills anyone working with individuals who have experienced trauma need to have. As O’Hagan noted, the training needed for survivor leaders are not different from non-survivor leaders.

Specific to this study, and consistent with O’Hagan’s (2009) challenges related to the deficit-based view, organizations should strive for more balanced rules and expectations within the organization, similar to the practices set in place by SAGE (Hotaling et al., 2003). We view this as the most challenging psychological and practical shift for the organizations included in this study. The organizations are all religious-based organizations. Sex outside of marriage is not consistent with their beliefs. Yet, four participants continued to engage in the sex trade after exiting, despite rules against doing so being in place within the organizations. Several organizations discouraged cursing. Cursing was part of the participants’ authentic dialect. A shift in the rules in place from a deficit-based view, which is controlling and reduces survivors’ power, to a harm reduction view could improve organizations’ outcomes and encourage survivors.

Future Research

This study provided definitive support for engaging survivor leaders to improve relatability and provide hope for users. There is a clear argument for survivor involvement to address power imbalances. However, additional research should be done to investigate best practices in organizations engaging survivors with equal distribution of power and resources. For example, O’Hagan (2009) purported training to be the best way to ensure survivor run initiatives and organizations. Future research could investigate the most effective survivor training methods and programs for participants and survivor leaders. Harris and Larsen (2007) found a positive impact on the peer counselors supporting HIV positive-people. Perhaps a similar benefit is offered to survivor leaders operating in supportive and empowering environments in the organizations supporting women transitioning out of the sex trade.

In conclusion, survivor leadership was meaningful to women transitioning out of the sex trade. Survivor engagement in their education, counseling, and management of organizations gave women individuals with whom they could relate, provided them with hope, and helped address issues of power imbalance within organization. Adoption of survivor-led initiatives could help organizations empower participants to determine their own plans for recovery and development, without imposing potentially oppressive rules on participants. Models exist, along with lessons learned, for successfully engaging survivors at all levels—volunteers, staff, and leaders—and in various roles—managers, counselors, and educators. The findings in this study show organizations will better serve women exiting the sex trade by treating them and the survivor leaders as experts in their own, unique experiences and needs.