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The Application of Ethical Principles in Treating Juju Believing Nigerian Sex Trade Survivors.

Introduction

A mental health professional that works with a Nigerian woman who used to be a commodity in the sex trade faces a series of ethical challenges regarding the latter's spiritual beliefs. If spirituality can be defined as a process in which a person looks for something greater than the world they live in to guide their important decisions and to trust when in need of support (Senreich, 2013), Nigerian women's beliefs in the juju can be considered spiritual. But can a therapist of the west, whether they be American or European, work with or around the juju? With the American Counseling Association and the International Association of Marriage and Family Counselors forbidding a therapist to force their own beliefs on their clients and forewarning the former not to act as spiritual counsellors (Wiggins & Frame, 2016), what is the jurisdiction of the psychologist? Furthermore, in treating Nigerian women that were former sex workers, does spirituality collude or does it collide with therapy?

Spirituality can act both for and against therapy suggests the example of African American people, early in adulthood, who suffer from depression. Religion, they testify, can help fight against depression through celebrating positive feelings and through promoting action to overcome difficulties. It can also dissuade them, however, from asking for therapeutic help when they need it, making them believe that God can solve all of their problems (Breland-Noble, Wong, Childrens, Hankerson & Sotomayor, 2015). Recent developments in the field of psychology have acknowledged this dual capacity of spirituality, both to heal and to hold people confined in a frame of insularity (Kvarfordt, 2010) and have attempted to integrate the two fields in a way that is most beneficial to the client (Plante, 2007).

Aiming at integrating Nigerian women's spiritual beliefs in their therapy after surviving sex trafficking, with a professional that was trained in and for the west, the author begins by describing to what extent these women are requesting our help nowadays. She continues by discussing how the juju interferes with their commitment to therapy and how it can be life-threatening in their case and what efforts have been made to fight sex slavery through the juju. She also presents how traditional western therapy would fail to treat them if implored alone, as well as what has been done in their country of origin to aid them. To help guide a therapist of the west who is working with an un-enslaved Nigerian woman to ethical practice, she concludes with a suggestion of how the Ethical Principles of Psychologists and the Code of Conduct created by the American Psychological Association can be attended to and respected in working with this population.

Nigerian Women Requesting our Help in the West

Before moving forward to a review of the statistics about the presence of Nigerian sex workers in Europe and the United States, a definition of human and specifically sex trafficking is needed. Human trafficking is basically the handling of human beings as products to be traded for profit nationally and internationally through threats, defrauding, and physical and emotional exploitation. The commerce of humans can aim at selling and buying sex slaves, cheap working hands and people whose organs will be harvested for illegal surgeries to save others' lives. Sex trafficking is exactly the type of exchange in which an individual is forced into prostitution while being emotionally and physically abused, most often through rape but also through battering (Efrat, 2015).

As therapists in the American and the European continent, how often do we encounter Nigerian sex trade survivors? Without a clarification regarding the nationality of sex trafficking victims who find themselves in America, the National Human Trafficking Hotline reports having received 22,191 calls from 2007, while almost 5 million people are enslaved in sex trafficking worldwide (Polaris, 2018). European surveys reveal 30,146 cases across the twenty-eight European Union members from 2010 to 2012 only (Eurostat, 2015). And these are only the cases that were reported. Specifically regarding Nigeria, local authorities announce that 80 percent of the women who flee the country in search for better opportunities in Italy, are trapped into sex trade and that this percentage has been consistent during the last fifteen years (National Agency, 2017).

These either flee their countries knowing that they will be trafficked or are trapped in the trade of humans for sex. "Le droit de l' homme", translated as "the right to be trafficked", is a way in which young African women claim freedom from parental control and decide that a life in prostitution is preferable to living under surveillance of their mothers and fathers who dictate their every move. They thus travel from Togo to Nigeria where they give themselves up to prostitution, to absolve themselves from the burden that they face at home (Piot, 2011). Most often, however, Nigerian girls and women are bated into the trafficking system by being promised a job opportunity in the West, in order to escape the financial banes, the political corruption and the social abasement of women in their country (Chong, 2014).

In the fortunate occasion that enslaved Nigerian women escape the sex trade and find themselves free from their traffickers, they have one of two options. Either return to Nigeria or stay in the country that they are in and be offered material and psychological support. The women who return, however, often face rejection by their families who are ashamed of their work in prostitution. They are thus sent away once again and are robbed of their familial bracing system that could otherwise be central to their recovery (Pela, 1982). Unsupported in their homeland, they usually decide to return to the sex trade not for financial reasons but out of profound fear of death or illness bestowed upon them by a manipulation of their beliefs in the juju by their traffickers (National Agency, 2017). This spiritual fear will be thoroughly analyzed in the proceeding sections of this article. The other option that these women have is to stay put in European or American territory and receive help by governmental (Williamson, Dutch & Clawson, 2008) and private initiatives (Seals, 2014) that can have the form of community day-centers (Clawson & Goldblatt Grace, 2007), temporary hosting facilities (Reichert & Sylwestrzak, 2013) or more permanent shelters (Office of Criminal Justice, 2017). Both American (Johnson, 2012) and European facilities aim to service these women with focus on their traumatic experiences and with respect to the cultural background that they derive from (Koricanac, 2013).

The Juju Counteracting Therapy

As mentioned earlier, spiritual beliefs of a client can work for or against the therapeutic goals (Breland-Noble, Wong, Childrens, Hankerson & Sotomayor, 2015). But what happens in the case of the juju? What does this belief entail and how is it present in the efforts to help Nigerian women who have escaped sex trafficking through psychotherapy? The juju is the French adaptation of the unnamed religion of the Yoruba population that consists of 40 million people worldwide, many of which reside in Nigeria. Deriving from the French verb "jouer" which means "to play", juju refers to the small, carved objects, resembling a toy, that Nigerian people believe hold their luck. Nigeria is a country of many religions, but juju is the most prevalent in it after Christianity and Muslim beliefs. Juju is also prevalent across the globe, with 6 percent of the world's population believing in it. According to the juju, people's fate is determined before their birth and is governed by two types of spirits. These are the spirits of the "living- dead", the people who died recently but who still survive through the memories of people who met them, including relatives or other acquaintances that are still alive, and of the "dead- dead", the people who lived years ago and whose recollection is no longer apparent in everyday life since no one who met them is alive.

While the first types of spirits protect people, especially rewarding them if they act benevolently towards their community, the spirits of the long-dead people are there to haunt those who are alive (Ilesamni, 1997). So how is the juju related to sex trafficking? The answer is found in the manipulation of this belief by traffickers who use Nigerian women's spiritual beliefs to blackmail them into staying captive in sex slavery for years on end. What human traffickers do is recreate a juju ritual using a priest, a symbolic object and a ceremony to convince women that they need to commit to sex work, to abide to all of their orders and to never reveal their experiences to the authorities (Mancusco, 2013). To create the actual juju, the object that will haunt them, traffickers collect hair from different parts of their bodies, nail clippings and some blood to bind them together into an article that will be their link to the "dead-dead" spirits that will look after their every move and will intervene in case they break the agreed-upon terms (Dunkerley, 2017). If they break these rules, the spirits will kill them or their loved ones, will make sure they grow fatally ill, or they will destroy all of their possessions (Watt & Kruger, 2017).

While these threats may seem fictitious to the western therapist, Dr. Siddharth Kara, the director of the "Human Trafficking and Modern Slavery" course in Harvard Kennedy School of Government, alerts that these are very much real to Nigerian women. This is why they not only decide to give up their recently acquired freedom to return to sex labor out of fear of this curse (National Agency, 2017) but also refuse to disclose any information that would be vital to the dismantlement of human trafficking in Europe and the United States (Kara, 2017). Even though granted freedom, Nigerian women believe that spiritual forces are still watching them, demanding that they return to sex slavery. This terror is not only unappeased through the reassurances of a western therapist (Rosen, Greene, Young & Norris, 2010) but also creates an urgency in the sufferers to return to exploitation in order to survive (Macy & Johns, 2010).

Fighting Sex Trafficking through the Juju

While academic literature has not yet depicted the efforts of governmental agents to fight against sex slavery using the very same mean that facilitates it, that is the juju, enlightening to this essay are media publications depicting the efforts of both African and English leaders to think creatively in order to battle forced sex labor. In an article by Aryn Baker for Time magazine, published in April 2018, Ewuare II, a West African ruler, is said to use the juju to absolve Nigerian people of all spiritual obligations to suffering. In a ritual involving 500 juju priests, Ewuare resolved all spiritual dictations binding Nigerian people to sex slavery. He then called their families to take back the jujus created by their bodily products, not only forgiving them for their sins in prostitution but also encouraging the community to accept them back (Baker, 2018).

Paul Peachey described in a publication for The Independent in February 2015 how Kevin Hyland, the United Kingdom Government's first anti-trafficking official, went on a tour in Africa in which he too used an alternative way to abolish sex slavery. What he did was to work with Nigerian officials to reach the priests who cursed sex slaves and to force them to reverse the spell.

Once the spell is reversed, Hyland knew, victims would be willing to disclose information about their traffickers and the experiences they endured (Peachey, 2015). With no information about the results that this effort yielded, all the public was left with was an announcement made through the Thompson Reuters Foundation this year declaring that Hyland would abandon his duties as the first anti-slavery politician (Guilbert, 2018).

Despite the lack of information on the efficacy of these tactics, it is interesting to point out the willingness of African and European officials to integrate spiritual practices in the political battle against human trafficking. While the tactic of acknowledging and being resourceful with the population's spiritual beliefs and keeping their benefit in mind is an incipient attempt, these initiatives can be informative to an ethical approach to help Nigerian women through psychotherapy in a western context.

If Western Psychotherapy were to Act Alone

Aiming at applying the integrative thought authorized by government officials between spirituality and fields that abut human trafficking, it is interesting to visit the question of how would a western mental health professional handle a Nigerian female client on their own. When found in therapeutic context, Nigerian women tend to remain silent until they break away from any effort to help them (Akor, 2011). They often do not disclose information about the juju or the fear that petrifies them, misleading the therapist to a diagnosis of major depressive disorder without being able to clarify what precipitated its onset (Fayomi, 2009).

In the rare occasion that a Nigerian woman would admit to her terror about the curse, a therapist who was not culturally competent, that is being conversant of his or her client's cultural and spiritual background (Bartel-Radic & Gianelloni, 2017), might identify a key manifestation of delusional thinking based on the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders. More specifically, the client's beliefs that she was being watched and conspired against by evil spirits might suffice to provide a diagnosis for Persecutory type of Delusional Disorder. According to the manual, however, cultural and religious information should be taken under consideration before establishing a diagnosis (American Psychological Association, 2013). Given this provision, the foundations of an ethical practice guide to treating Nigerian sex trade survivors may be established, since western therapy on its own is until now proven to have minimal effects in the alleviation of these women's distress (Okogbule, 2013).

APA's Ethical Principles of Psychologists and Code of Conduct: Application in Working with Nigerian Women Formerly Enslaved in the Sex Trade

To create a suggestion regarding the ethical aspects of engaging in therapy with emancipated women from Nigeria who were formerly enslaved in the sex trade, the author has used the Ethical Principles of Psychologists and the Code of Conduct created by the American Psychological Association (APA), effective since January 1st, 2017 as her framework. In this background, she has chosen the sections of the principles that she found most closely related to the question of how to work with a freed Nigerian who was formerly enslaved in the sex trade, namely section 1, General Principles, 2, Competence, 3, Human Relations, 4, Privacy and Confidentiality and 10, Therapy (American Psychological Association, 2017).

General Principles

Having a suggestive and inspiring quality, the General Principles section recommends that psychologists aim at "Beneficence and Nonmaleficence, Fidelity and Responsibility, Integrity, Justice and Respect for People's Rights and Dignity". "Beneficence and Nonmaleficence" are described by APA as caution to prevent any type of harm from happening to the client. In the case discussed here, a therapist carries the enhanced fear of doing something to disconvince the Nigerian woman from accepting help and indirectly leading her back in the trafficking cycle (Abas, Ostrovschi, Prince, Gorceag, Trigub & Oram, 2013). To counter such a fear, a therapist should be sensitive to their client's fears and not discredit them as being unrealistic, as Nigerian women often mention being disappointed by the therapeutic services appointed to them because they seemed uninformed of their own beliefs (Rosen, Greene, Young & Norris, 2010).

The aspect of danger associated with a Nigerian woman declining help and drifting back into trafficking is even more important in discussing "Fidelity and Responsibility". With therapists aiming to protect their clients from exploitation or harm, the debate of negotiating cultural and religious values remains unresolved. While emancipated women are no longer physically in danger, even though their traffickers may in fact be after them in order to retrieve their source of income (Zimmerman, Hossain & Watts, 2011), they are often a threat to their own selves by willing to return to sex labor out of fear cycle (Abas, Ostrovschi, Prince, Gorceag, Trigub & Oram, 2013). So what is the room for action of a therapist who is trying to dissuade her from going back? A response to this question could be to appease her urgency to return in some way or to try to convince her to devote some time before deciding on whether she wants to go back. The optimal strategy for a therapist whose client is anxious to go back is to earn some time.

Regarding "Integrity", a mental health professional should express all of his or her doubts, concerns and his or her own cultural stance in trying to help the client. Assuming that his or her primary goal is to alleviate her tension and her fear by finding a way for these spiritual binds to be resolved and to set her free, a therapist could be open in discussing how he or she views the matter of spiritual entrapment through the juju. In doing so, not only is he or she genuine (Kensit, 2000) but he or she is also not trying to trick his or her client into breaking free. He or she is honest and open about his or her concerns and about what his or her goal is. He or she can say something as simple as "What I want to see happening is you breaking free from the handcuffs that cause you profound fear. If you too want to break free, can we work together in finding a way to facilitate this?".

With "Justice" referring to the provision of the therapist that prevents him or her from imposing his or her personal beliefs on the client and from lacking training in the case he or she is called to undertake, APA's recognition of religion as one form of heterogeneity across clients can be helpful in finding an ethical way to achieve this goal. The Association suggests that therapists are careful and respectful towards diverse values but are also trained to be able to process and handle the information that they receive from their client (Plante, 2007). Reading as much as they can about Nigerian religious culture and the impact of spirituality in people's everyday lives as well as engaging a Nigerian person that is not their client in a discussion about matters of spirituality and the juju can be of great value in the effort of a therapist to help their Nigerian client.

"Respect of People's Rights and Dignity" is one of the most vital issues to be considered when working with a formerly trafficked sex worker. The conflict that arises in this case lands between article 18 and article 1 of the Universal Declaration of Human Rights, established by the General Assembly of the United Nations in 1948 (General Assembly of the United Nations, 2016). Article 18 declares that people have the freedom to choose and change their religious beliefs, while Article 1 states that all humans are free. In the case of formerly incarcerated Nigerian women that were forced into sex labor, a therapist is found in the position to prioritize between these dictations. The challenge that they are facing is the following: the Nigerian woman is legally free yet remains spiritually bound to torture. Additionally, these spiritual bounds trigger an urgency for her to, voluntarily, return to sex work. This means that her freedom is at stake. In the meantime, by being afraid she follows her spiritual beliefs. A middle way that respects both Articles of the Declaration could be to educate these women about the way in which traffickers abused their religious beliefs (Ilesamni, 1997) to keep them captive. This way, the therapist is not discrediting the religious beliefs of their client and is trying to shed light on how traffickers exploit these respectful ideals to take advantage of their convictions. This way, the therapist proves that they respect their clients' right to religion and that they try to protect it from predators.

Competence

The specifiers of the section of Competence that are useful in discussing Nigerian female clients are "Boundaries of Competence, Maintaining Competence and Bases for Scientific and Professional Judgements". To grow competent to help a client of this origin, a therapist is challenged more than treating anyone from the west with a foreseeable past that has been handled through therapeutic experience. Here, however, scarce literature exists to guide a professional in helping a Nigerian woman out of the entrapment of sex trafficking. If being competent means being able to help a client (American Psychological Association, 2017), even though a therapist should acknowledge the "Boundaries of his Competence" that are bound to the western nature of their education and experience, he should not arrest all efforts to help the Nigerian client. Since little work is done in the field of psychology to unchain women from the bane of sex slavery, a professional should commit to expanding his competence by studying their cultural and religious background (Fairburn & Cooper, 2011) and finding the space that is allowed in it to challenge and break free from slavery. Along this vein, "Maintaining their Competence" can be translated into committing to ongoing research on the origins of their clients. This can also mean collaborating with them in acquiring more information about their religion by asking them both direct questions about it as well as by requesting directions on where to research for more information (Imel, Baer, Martino, Ball & Carroll, 2011) such as Nigerian online forums or indicative books. These suggested practices also adhere to the need for "Bases for Scientific and Professional Judgements" in that therapists seek for academic corroboration of their findings. Since there is a void of specific published information and guidance, they could consult with political, legal and sociological agents in establishing guidelines themselves in order to help others (Fredrickson, 2001).

Human Relations

The section of the Ethical Principles and the Code of Conduct created by the APA that refers to the relationship between the client and the therapist as well as other people in their surrounding environment includes "Avoiding Harm, Cooperation with other Professionals, Informed Consent and Interruption of Psychological Services" as clarifications that can be useful in treating the Nigerian client. The main goal or concern of the therapist here in "Avoiding Harm" is keeping the woman who wants to reenter sex slavery from doing so (Hossain, Zimmerman, Abas, Light & Watts, 2010). As suggested in the "Fidelity and Responsibility" part of Section 1, taming their urgency to go back and earning some time could serve this goal.

"Cooperation with Professionals" is crucial in this case where, as mentioned above, research and guidelines are scarce. Asking Nigerian officials about information, requesting help from legal authorities, gaining information by political factors who will decide upon the legal status of these women in a foreign country (Hojholt, 2011) can work favorably to the therapeutic process of these women.

Getting creative inspiration from professionals of different fields, such as governor Ewuare II and Kevin Hyland, can also be valuable in working with such cases. In discussing "Informed Consent" of clients, therapists should not only make sure that Nigerian women have agreed to receiving therapeutic help but that they are also aware of the goals of therapy. This means that the professional should clarify that he or she is not there to adulterate her spiritual beliefs, nor to guide her in a different religious stance (Wiggins & Frame, 2000) but that his or her goal is to work with her to alleviate her distress.

While some Nigerian women that have been trafficked have acquired legal travel documents through their traffickers, they often escape without having hold of their passports (Mancuso, 2013). Others that were trafficked as illegal migrants in America or Europe find themselves seeking asylum from the country in which they were emancipated or travelling to different lands to start over (Haaken & O'Neill, 2013). In both occasions, Nigerian women are open to the possibility of relocation. This means that the therapeutic relationship may be interrupted. "Interruption of Psychological Services" suggests that therapists try to overcome this challenge and remain committed to the therapeutic goals. In this case, this could mean that they offer therapy through Skype or other platforms that surpass geographical challenges (Bell, 2013) or that they help their client research therapeutic facilities in their new homeland (Moola, 2016).

Privacy and Confidentiality

"Maintaining Confidentiality and Use of Confidential Information for Didactic or Other Purposes" are the two clarifications of the section on Privacy and Confidentiality that are germane to treating Nigerian women. Confidentiality of Nigerian female clients is not only ensuring that her privacy and her disclosures are kept from exposure to third parties but also ascertaining that they are not traceable by their traffickers (Bishop, 2016). Since the experience and the information gathered through working with a Nigerian woman in a therapeutic context can be enlightening to guiding professionals who will engage with similar clients in the future and the transcription of the lessons learned in academic articles can facilitate this goal, information can be used for didactic purposes. Before using it, however, a therapist should grant the client's consent and legal consent in releasing the information and should disguise their identity using pseudonyms according to APA guidelines (American Psychological Association, 2017).

Therapy

The clarifications of this section that are relevant to treating Nigerian women are "Informed Consent to Therapy and Interruption of Therapy". Information about the "Informed Consent to Therapy" can be found in the suggestion made about the "Informed Consent" clarification of Section 3 and about "Interruption of Therapy" in the "Interruption of Psychological Services" of the same section.

Discussion

While all the Ethical Principles created by the APA should be respected in treating a formerly enslaved Nigerian woman, the specific ones described in this essay can be tailored specifically to help them, given their uniquely torturous past. As mentioned in the aftercare section of this paper, therapists who treat trafficked women are usually operating within the context of a governmental or a humanitarian institution. This could imply that they have the resources and the willingness to commit to research in how to help the women that come from a completely different world than their own.

In preparing this article, the author was aware of the value of cross-cultural experiences in offering perspective to the western therapist. This could entail realizing the limits of their expertise but also the boundaries of their education, of their skill-set and of their cultural background (Eliaz-Juarez & Knudson-Martin, 2016). While working with a Nigerian formerly enslaved in the sex trade can be challenging in multiple levels, it can enhance both the research interest of the mental health professional and their creative potential in working within an unknown spiritual context. Since the integration of Spirituality in psychotherapeutic literature and practice is a nascent field to be explored, contributions of interested parties in researching and discussing ways of this conceptual collaboration are of great value in helping the Nigerian client.

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Daphne Catherine Spyropoulos

spyropoulosdaphne@gmail.com

MSc candidate, Deree-The American College of Greece Agia Paraskevi, Greece
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Author:Spyropoulos, Daphne Catherine
Publication:Journal of Pan African Studies
Article Type:Report
Geographic Code:6NIGR
Date:Nov 15, 2018
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