Module 6: Psychological Evidence of Torture and Ill-Treatment

Objectives

• To appreciate the central role of psychological evaluation in medical evaluations of torture and ill-treatment
• To understand how to conduct a psychological evaluation, document psychological findings, and formulate clinical impressions and conclusions regarding torture and ill-treatment
• To review transference, counter-transference, re-traumatisation issues
• Using the Psychological Evaluations # 1 and #2, students will be asked to develop interpretations of the psychological findings and conclusions and recommendations using Istanbul Protocol standards
• To understand the value and limitations of diagnostic classifications (ICD-10 and DSM) in the evaluation of psychological evidence of torture and ill-treatment
• To understand the value and limitations of psychometric instruments (questionnaires, scales, etc) during the psychological evaluation
• To be familiar with psychological evaluations of torture and ill-treatment in children

Content

• The central role of the psychological evaluation
• Conducting the psychological evaluation
• Psychological findings and diagnostic considerations
• Components of the psychological/psychiatric evaluation
  • Identifying Data
  • History of Torture and Ill-treatment
  • Current Psychological Complaints
  • Post-torture History
  • Pre-torture History
  • Medical History
  • Past Psychiatric History
  • Neuro-psychological Assessment
  • Mental Status Examination
  • Assessment of Social Function
  • Psychological Testing and the Use of Checklists and Questionnaires
  • Clinical Impression
  • Recommendations
  • Treatment Considerations
• Children and Torture
  • Developmental Considerations
  • Clinical Considerations
  • Role of the Family
• International statistical classification of diseases and related health problems, Annex

Discussion Topics

• Students should work in groups or individually on one or both of the Psychological Evaluations (#1 and #2, see Appendix I at the end of this Module). Each group should write up their interpretation of findings and conclusions and recommendations.
• Additional Discussion Topics:
  • Discuss the reasons why some survivors of torture have difficulties recalling and recounting their experiences
  • Discuss possible reasons for inconsistencies in the evaluation and strategies to explain inconsistencies in medico-legal reports
  • Discuss how to assess the possibility of simulation of psychological symptoms
  • Discuss who can/should conduct the psychological evaluations in your country (consider: qualifications, authority, official vs. non-official, etc)
  • Discuss current, country-specific challenges in conducting psychological evaluations of torture and ill-treatment and their validity, or lack thereof, in medico-legal contexts

Teaching Formats

• Group Activity:
  • Students should work in groups or individually on one or both of the Psychological Evaluations (#1 and #2, see Appendix I at the end of this Module). Each group should write up their interpretation of findings and conclusions and recommendations based on Istanbul Protocol standards.
  • 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
• Alternative Option:
• Divide the class into several groups and assign each group with one or more (or all) of the Discussion Topics
• Follow the usual sequence for conducting group activities as outlined above
• Individual Research/Assignment:
  • Individual students should assigned to read one or both of the Psychological Evaluations and write up their interpretation of findings and conclusions and recommendations based on Istanbul Protocol
• Journal Entry: (Instructor to assign; Write a few paragraphs — no more than a page)
  • Respond to one or more of the Discussion Topics
  • In your opinion, what are the most significant challenges in conducting a psychological evaluation of torture and ill treatment? Explain.

Primary Resources

• The Istanbul Protocol, Chapter VI
• Psychological Evaluation of Torture Allegations: An International Training Manual
• The Medical Documentation of Torture
• Medical Investigation and Documentation of Torture: A Handbook for Health Professionals
• Trainers’ Guidelines for Health Professionals: Training of Users