Module 3: Interview Considerations

Past Medical History

Obtain a complete medical history, including prior medical, surgical and/or psychiatric problems. Be sure to document any history of injuries before the period of detention and any possible after-effects. Knowledge of prior injuries may help to differentiate physical findings related to torture from those that are not.

Obtain a complete medical history, including prior medical, surgical and/or psychiatric problems. Be sure to document any history of injuries before the period of detention and any possible after-effects. Knowledge of prior injuries may help to differentiate physical findings related … Continue reading

Trust

Trust is an essential component of eliciting an accurate account of abuse. Earning the trust of someone who has experienced torture or other forms of abuse requires active listening, meticulous communication, courtesy and genuine empathy and honesty. Clinicians must have the capacity to create a climate of trust in which disclosure of crucial, though perhaps very painful or shameful, facts can occur. It is important to be aware that those facts are sometimes intimate secrets that the person may reveal at that moment for the first time.

Clinicians should explain what to expect in the evaluation. The clinician should also be mindful of the tone, phrasing and sequencing of questions (sensitive questions should be asked only after some degree of rapport has been developed) and should acknowledge the interviewee’s ability to take a break if needed or to choose not to respond to any question.

Trust is an essential component of eliciting an accurate account of abuse. Earning the trust of someone who has experienced torture or other forms of abuse requires active listening, meticulous communication, courtesy and genuine empathy and honesty. Clinicians must have … Continue reading

Summarising and clarifying

During the interview, it is often helpful to clarify points, in order to ensure that the information is accurate. For example: ‘When you say that you were suspended by your arms, in what position were they?’ Alternatively the individual can be asked to recreate the position, but it should be borne in mind that doing so could provoke uncomfortable feelings or other reactions in the individual.

At the end of each session, it generally helps to summarise the key points, to ensure that they are clear. This sometimes has the additional benefit of getting the individual to remember details that add to the narrative.

In medico-legal cases, it may be helpful to have an opportunity to meet with the individual again to review any questions or inconsistancies. This also provides an opportunity to follow up any clinical problems that may have been identified in the evaluation.

During the interview, it is often helpful to clarify points, in order to ensure that the information is accurate. For example: ‘When you say that you were suspended by your arms, in what position were they?’ Alternatively the individual can … Continue reading

Interview Content

Summary of Detention(s) and Abuse

Before obtaining a detailed account of events, elicit summary information, including dates, places, duration of detention, frequency and duration of torture sessions. A summary will help to make effective use of time. In some cases where survivors have been tortured on multiple occasions, they may be able to recall what happened to them, but often can not recall exactly where and when each event occurred. In such circumstances, it may be advisable to elicit the historical account by methods of abuse rather than as a series of events during specific arrests.

Similarly, in taking a history it may often be useful to have “what happened where” documented as much as possible. “Holding places” are often operated by different security/police/armed forces, and what events happened in different places may be useful to get a full picture of the torture system. Obtaining a map of where the torture occurred may be useful in piecing together different histories from different people. This will often prove very useful for the overall evaluation.

Before obtaining a detailed account of events, elicit summary information, including dates, places, duration of detention, frequency and duration of torture sessions. A summary will help to make effective use of time. In some cases where survivors have been tortured … Continue reading

Informed Consent

Clinicians must ensure that informed consent is based on adequate disclosure and understanding of the potential benefits and adverse consequences of a medical evaluation and that consent is given voluntarily without coercion by others, particularly law enforcement or judicial authorities. The interviewee has the right to refuse the evaluation. In such circumstances, the clinician should document the reason for refusal of an evaluation. According to the Istanbul Protocol:

Medical experts involved in the investigation of torture or ill-treatment shall behave at all times in conformity with the highest ethical standards and, in particular, shall obtain informed consent before any examination is undertaken.

— (Istanbul Principle 6(a))

From the outset, the alleged victim should be informed of: the nature of the process, why his/her evidence is being sought, how the information given by the person would be used and possible consequences.

As stated in Module 2, Informed consent requires that the consenting individual:

  • Is mentally competent
  • Receives full disclosure of information, including risks, benefits, and clarification of the limits of confidentiality that may be imposed by State or judicial authorities.
  • Understands the information provided
  • Gives his/her consent voluntarily
  • Provides authorisation for his/her consent

Clinicians must ensure that informed consent is based on adequate disclosure and understanding of the potential benefits and adverse consequences of a medical evaluation and that consent is given voluntarily without coercion by others, particularly law enforcement or judicial authorities. … Continue reading

Difficulties Recalling and Recounting

Torture survivors may have difficulties in recalling and recounting the specific details of the torture experience and other parts of the history for several important reasons. Clinicians should be familiar with such factors as they commonly manifest as inconsistencies in the interview. Difficulty recalling and recounting may be related to:

  • Factors directly related to the torture experience
    • Factors during torture itself, such as blindfolding, drugging, lapses of consciousness, etc.
    • Disorientation in time and place during torture due to the nature of torture or extreme stress experienced during torture.
    • Neuro-psychiatric memory impairment resulting from head injuries, suffocation, near drowning, starvation, hunger strikes or vitamin deficiencies.
    • Experiencing repeated and similar events may also lead to difficulties in recalling clearly the details of specific events.
  • Factors related to the psychological impact of torture
    • PTSD-related memory disturbances recalling the traumatic event or intrusive memories, nightmares and the inability to remember important details of the event.
    • Denial and avoidance, which can be protective coping mechanisms, in these particular circumstances.
    • High emotional arousal and impaired memory secondary to trauma-related mental illnesses, such as depression and post-traumatic stress disorder.
    • Other psychological symptoms such as concentration difficulties, fragmentation or repression of traumatic memories, confusion, dissociation, amnesia.
    • Feelings of guilt or shame.
  • Cultural factors
    • Cultural differences in the perception of time.
    • Culturally prescribed sanctions that allow traumatic experiences to be revealed only in highly confidential settings.
  • Factors related to interview conditions or barriers of communication
    • Fear of placing oneself or others at risk.
    • Lack of trust in the examining clinician and/or interpreter.
    • Lack of feeling safe during the interview.
    • Environmental barriers such as lack of privacy, comfort of interview setting, inadequate time for the interview.
    • Physical barriers such as pain or other discomforts, fatigue, sensory deficits.
    • Socio-cultural barriers such as the gender of the interviewer, language and cultural differences.
    • Barriers due to transference/counter-transference reactions during the interview.
    • Inadequately conducted and/or poorly structured interviews.

Torture survivors may have difficulties in recalling and recounting the specific details of the torture experience and other parts of the history for several important reasons. Clinicians should be familiar with such factors as they commonly manifest as inconsistencies in … Continue reading

Module 3 Presentation: Interview Considerations


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Download Module 3: Interview Considerations (PowerPoint Presentation) (ppt)

Circumstances of Detention(s)

If there has been an arrest or any period of detention, the description should include details of the conditions of detention, especially the nature of the accommodation (including size, shape, space, natural and artificial light, temperature, ventilation, and hygiene), the daily routine, and access to water, food, sanitation, health care and the open air. All of these elements of arrest and detention can produce physical and psychological manifestations (e.g. malnutrition, vector-borne disease, anxiety, etc).

Consider the following questions: What time was it? Where were you? What were you doing? Who was there? Describe the appearance of those who detained you. Were they military or civilian, in uniforms or in plain clothes? What type of weapons were they carrying? What was said? Were there any witnesses? Was this a formal arrest, administrative detention, or disappearance? Was violence used, threat spoken? Was there any interaction with family members? Note the use of restraints or blindfold, means of transportation, destination, and names of officials, if known.

If there has been an arrest or any period of detention, the description should include details of the conditions of detention, especially the nature of the accommodation (including size, shape, space, natural and artificial light, temperature, ventilation, and hygiene), the … Continue reading

Module 3: Interview Considerations

Objectives

  • To understand the key role of the interview in conducting medical evaluations of torture allegations
  • To be familiar with conditions necessary for an effective interview
  • To understand and develop interview process skills such as empathy and earning trust
  • To learn effective and appropriate techniques of questioning
  • To understand the effect of the interviewing style on the interview process and the alleged victim
  • To develop the capacity to elicit a detailed narrative account of alleged experiences
  • To be familiar with possible difficulties of recalling and recounting elements of torture experiences
  • To understand how and why difficulties may arise during an interview
  • To be familiar with possible transference and counter-transference reactions
  • To develop awareness to possible vicarious traumatisation and burnout and discuss strategies to address their effects
  • To examine individual reactions to hearing a recording of an interview with a survivor of torture

Content

  • Preliminary Considerations
    • Purpose of medical evaluations
    • Interview settings
    • Trust
    • Informed consent
    • Confidentiality
    • Privacy
    • Empathy
    • Objectivity
    • Safety and security
    • Procedural Safeguards for Detainees
    • Risk of Re-traumatisation
    • Gender Considerations
    • Interviewing Children
    • Cultural and Religious Awareness
    • Working with Interpreters
    • Transference and Counter-Transference Reaction
  • Conducting Interviews
    • Types of Questions
    • Cognitive Techniques
    • Summarising and Clarifying
    • Difficulties Recalling and Recounting
    • Assessing Inconsistencies
  • Interview Content
    • Identification and Introduction
    • Psychosocial History- Pre-Arrest
    • Past Medical History
    • Summary of Detention(s) and Abuse
    • Circumstances of Detention(s)
    • Prison/Detention Place Conditions
    • Allegations of Torture and Ill-treatment
    • Review of Symptoms
    • Psychosocial History (post-arrest)
    • Assessments of Physical and Psychological Evidence
    • Physical Examination
    • Closing
    • Indications for Referral

Discussion Topics

  • Play audio (MP3 file [2] [1]) of National Public Radio interview with Sr. Dianna Ortiz (about 15 minutes) and discuss relevant interview considerations: confidentiality, informed consent, privacy, safety, objectivity, impartiality, creating a climate of trust, courtesy, honesty, empathy, the effects of interviewing style, appropriate use of open-ended and closed questioning, the risks of re-traumatisation and how to minimize the risk of re-traumatisation.
  • Discuss individual responses to the interview with Sr. Dianna Ortiz and discuss strategies for managing such reactions and limiting secondary trauma and “burn-out”
  • Discuss what you find most challenging about interviewing survivors of torture and ill treatment

Teaching Formats

  • Group Activity:
    • Listen to the audio (MP3 file [2] [1]) of National Public Radio interview with Sr. Dianna Ortiz (about 15 minutes) as a class.
    • Divide the class into several groups and have each group address the first two Discussion Topics above
    • A facilitator should be identified to moderate the discussion and rapporteur should be identified to record the group’s findings and report them when the class reconvenes.
    • After 20-30 minutes of group discussion, the entire class should reconvene
    • Rapporteurs should briefly report on their group’s findings
    • Open class discussion
  • Individual Research/Assignment:
    • Research ways in which clinicians who work with survivors of torture deal with secondary trauma. Write a series of recommendations for colleagues who conduct medical evaluations of alleged torture victims on a regular basis, but are unaware of counter-transference issues
  • Journal Entry: (Instructor to assign Write a few paragraphs — no more than a page)
    • Consider your response to the audiotape of interview with Sr. Dianna Ortiz. Provide a series of recommendations to effectivel address these reactions and possibly others.
    • Discuss what you find most challenging about interviewing survivors of torture and ill treatment

Primary Resources

  • The Istanbul Protocol
  • The Medical Documentation of Torture
  • Medical Investigation and Documentation of Torture: A Handbook for Health Professionals
  • Psychological Evaluation of Torture Allegations: An International Training Manual
  • Audio of interview with Sr. Dianna Ortiz [3]. National Public Radio. 1996.
  • Trainers’ Guidelines for Health Professionals: Training of Users
  • Torture Reporting Handbook, Part II – Documenting Allegations

Objectives To understand the key role of the interview in conducting medical evaluations of torture allegations To be familiar with conditions necessary for an effective interview To understand and develop interview process skills such as empathy and earning trust To … Continue reading