Module 3: Interview Considerations

Interview Content

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

Module 3 Presentation: Interview Considerations


Download

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

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

Assessing Inconsistencies

Inconsistencies in a person’s story may arise from any or all of these factors. If possible, the investigator should ask for further clarification. These possibilities should be explored in detail. When clarification is not possible, the investigator should look for other evidence that supports or refutes the story. A network of consistent supporting details can corroborate and clarify the person’s story. Although the individual may not be able to provide the details desired by the investigator, such as dates, times, frequencies and exact identities of perpetrators, a broad outline of the traumatic events and torture will emerge and stand up over time.

If, on the other hand, the clinician suspects fabrication (sometimes called “simulation”), the clinician should try to identify potential reasons for exaggeration or fabrication, keeping in mind that fabrications may require detailed knowledge about trauma-related symptoms and findings that individuals rarely possess. It may be helpful to refer the individual to another clinician for a second opinion. If the suspicion of fabrication persists, it should be documented by both clinicians.

Inconsistencies in a person’s story may arise from any or all of these factors. If possible, the investigator should ask for further clarification. These possibilities should be explored in detail. When clarification is not possible, the investigator should look for … Continue reading

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