Assessment and Treatment of Torture Survivorsongoing legal efforts to address torture? •Because...
Transcript of Assessment and Treatment of Torture Survivorsongoing legal efforts to address torture? •Because...
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Assessment and Treatment of Torture Survivors :
Resilience-Centered Healing
Adeyinka M. Akinsulure-Smith, Ph.D. Katherine Porterfield, Ph.D. &
Hawthorne E. Smith, Ph.D.
Bellevue/NYU Program for Survivors of Torturehttp://www.survivorsoftorture.org/
Bellevue/NYU Program for Survivors of Torture
• Founded in 1995
• Over 5,000 men, women and children served
• Over 100 countries represented in our client population
• Help to rebuild the bodies, minds, and spirits of people who have been tortured or persecuted.
HawthorneSmith,Ph.D.Bellevue/NYUPSOT
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Overarching Programmatic Philosophy
Strength/Resilience based approachNot just victims – but survivorsHelping to marshal internal and community resources
Holistic sense of the survivorInterdisciplinary approachMultiple stressors – many ways to intervene
HawthorneSmith,Ph.D.Bellevue/NYUPSOT
Extreme Challenges Experienced by Torture Survivors and Refugees
• Multiple losses
• Ongoing effects of recurrent/reinforcing trauma
• Social dislocation; war; trauma; torture; internally displaced in home country; flight and relocation in neighboring country; refugee camps; immigration processing; resettlement in USA
• Individuals will respond to these stressors in different ways
HawthorneSmith,Ph.D.Bellevue/NYUPSOT
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Physical and Emotional Scars of Torture
HawthorneSmith,Ph.D.Bellevue/NYUPSOT
IRCT IRCT
Common Reactions to Torture and Refugee Trauma
HawthorneSmith,Ph.D.Bellevue/NYUPSOT
Cognitive
Spiritual
Behavioral
Physical
Emotional
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Spheres of Marginalization• Educational Functioning
• Social Service Provision (logistical/financial)
• Legal Advocacy
• Vocational/Professional
• Social Functioning
HawthorneSmith,Ph.D.Bellevue/NYUPSOT
Trauma-Informed Approach to Service Provision
• Safety
• Empowerment
• “It does not have to be • therapy to be therapeutic.”
HawthorneSmith,Ph.D.Bellevue/NYUPSOT
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Interdisciplinary Approach to Healing
Hawthorne Smith, Ph.D.Bellevue/NYU PSOT
Community Connection
Spiritual Engagement
Emotional Relief
Medical Treatment
Social/Legal Support
Culturally Syntonic Interventions
• Flexibility of Treatment Techniques
• Holistic Approach
• Focus on Resilience – not Pathology
Hawthorne E. Smith, Ph.D.Bellevue/NYU PSOT
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How does one change the world...?
• Utilizing the experiences and insights of our clients
• Helping the voiceless find their voice
• Collaboration among and between disciplines
Hawthorne Smith, Ph.D.Bellevue/NYU PSOT
Wisdom, Courage, Hope
Our clients:
Mr. UMs. AMs. TMr. S
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Ms. X
Ms. X: ChronologyØ1996: Democratic partyØApril & Oct, 1998: Family members murdered Øon going verbal and physical harassment
and threats due to political affiliationØ2003: Verbal and physical acts of violenceØMarch, 2005: Attempted abductionØ June, 2005: Sexual violenceØ - Family flees, travel through ItalyØAugust, 2005: Family arrive in U.S.
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Ms. X
“Every day, my daughter says, ‘Why are you crying Mommy?’ I want to feel normal, have joy…”
Ms. XMr. X
J4 months
The X Family
M3
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Considerations for Treatment
� Who is this person?� Why now and what are the expectations?� Safety and trust� Psychoeducation� Practical needs/ basic necessities� Racial/Cultural factors� What types of interventions will be used
and why?
Barriers/Challenges to Seeking and Utilizing Mental Health Services
vRefugee TraumavLack of information/knowledgevShame/stigmavGuiltvFearvIsolationvRacial/Cultural factorsvLanguagevLegal – the asylum process
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Integrated Care� Intake� Primary Care◦ Medical check up
� Mental Health ◦ Orientation Group◦ Individual Psychotherapy and/or Group◦ Psychiatric services
� Social Service Support◦ Metro cards◦ Housing Assistance◦ English language classes
� Legal Support
Our treatment process
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Ms. X: Asylum Process
Ø August, 2005: Family arrive in U.S.
Ø 2006: Asylum interview
Ø Jan, 2007: Intake at PSOT
Ø Dec, 2007: Asylum hearing, Immigration Court
Ø June, 2008: Asylum hearing, Immigration Court
Ms. X and her family, a “typical” forced migrant family
� Repeated Traumatic experiences: EXPOSURE
� Separation from family members: FAMILY DISRUPTION
� Range of psychological reactions in one family: RISK and RESILIENCE
� Participating in multiple unfamiliar systems: ACCULTURATION/RESETTLEMENT STRESS
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Theroleofpsychologistsinassessingtortureforlegaland
forensicpurposesAsylumandbeyond
Whatarethevariouslegalcontextsinwhichapsychologist’sassessmentof
tortureisrelevant?• Asylum• Humanrightstrials/WarCrimesTribunal• Criminalcases(VictimofcrimeorDefendant)• Civilcases(Damagesorotherrelief)
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Ineachofthesecontextsyouareusuallyansweringreferralquestions:
ASYLUM WARCRIMESTRIBUNAL CRIMINAL CIVIL
Whathappenedtotheperson? ✔ ✔ ✔ ✔
Whodidthistotheperson? ✔ ✔ ✔ ✔
Howdidwhatwasdoneaffecttheperson?
✔ ✔ ✔ ✔
Whatwouldhelpthepersonrecover?
✔ ✔ ✔ ✔
Implicitinthesequestionsis:
• Questionaboutcredibilityofclient• Questionaboutwhattorturedoestopeople• Questionabouthowpeoplerecoverfromtorture
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Court’sremedycouldbe:
• Asylumorotherimmigrationstatuschange• Financialremedy• Convictionofperpetrator• Someotherlegalruling,suchassuppressionofstatementsmadeundertorture
• Recognitionoftortureforreconciliation,amnesty,etc
Recognizingthatyouarenotthefact-finder
• NOTyourjobtodetermineproperconsequence—financialorotherwise
• NOTyourjobtodetermineguiltorinnocenceofaperpetrator
• NOTyourjobtomakeimmigrationdetermination
• YOUAREASSESSINGANDOPININGONTHESUBJECT’SEXPERIENCEOFTORTURE
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Assessingtortureforasylumwhenyouhaveaclinicalrelationshipvs.an
evaluationonlyClinicalrelationship• Canmovemoreslowly
throughmaterial• Credibilityofclientisimplicit• Writtenreportcanhaveless
focusonfull,detailednarrativeandmoreonclinicalpresentation,therapeuticreaction
• Canprepareclientfortestimony
• Canbeasourceofsupportforclientincourt
Evaluationonly• Oftenonly1-2sessionsfor
historytaking—Rapportisharder
• Willusuallyneedtoaddresscredibilitydirectly
• Reportshouldhavethoroughreviewofhistoryanddetails
• Nocontactwithsubjectusuallyafterreport
Assessingtorturefor“nonclinical”purposes
• Recognizethattheinteractionwiththesurvivorcanbe
• Traumatizing• Healing/Therapeutic• BOTH
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Thoroughassessmentoftorture:
• IstanbulProtocol:ManualontheEffectiveInvestigationandDocumentationofTortureandotherCruel,InhumanorDegradingTreatment.UnitedNations;OfficeoftheHighCommissionerforHumanRights:Geneva,Switzerland.
• Guidelinesincludingproperinterviewing,ethicalconsiderations,documentationissues,andreportwritingcanbefoundhere.
Interviewconsiderations• Client’sreactiontoyou- gender,race,ethnicity,countryof
origin,sexualorientation;RELATIONSHIPTOPOWER• Interrogationdynamics• Client’sexperienceofrecounting—Havetheydoneitbefore?
ASK• Presenceoffragmentation,dissociation—OBSERVEand
COMMENToninreportifpresent• Useopen-endedquestionsuntilyouneedtoaskspecificones
– “Tellmeaboutwhathappenedtoyouintheprison...whathappenednext?VS“Didtheybeatyou?”
– Whenbeingspecific,explainwhy,“Iknowthesequestionsarehard,butit’simportantthatIreallyunderstandyourexperience…”
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Reportwriting
• Ifyoudidanevaluation,followIstanbulProtocolguidelineswhichmeans:– Conductpsychosocialhistoryoffxbeforetorture– Detaileddescriptionofsubject’sexperiences– Anydocumentationthatsupports– Clinicalobservationsofbiopsychosocialfunctioning
– MedicaldocumentationbyMDevaluator– Recommendations
Testifying
• Explainyourmethodology:clinicalinterview,standardizedmeasures,recordreview,etc.
• Forasylum,talkaboutwhatmadesubjectcredible(Details?Emotionaldistressduringinterview?Changeovertime?)
• Beabletotalkaboutmalingering/fabricatingandhowyouassess
• Summaryoftortureandofeffectsoftorture• Opinionifreturnedtocountry
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Assistingaclientinpreparation
• Anxietymanagement• Copingenhancement• Normalize• Psychoeducation• HelpingtheLAWYERhelptheclient
– Practicebutdon’toverpractice– Knowthe“hot”spots
Whyarepsychologistsimportanttoongoinglegaleffortstoaddress
torture?• Becausetortureissopsychologicallydamaging,psychologistsareessentialtotheworkofdocumentingandpreventingtorture,aswellastreatingsurvivors.
• Becausetheethicalfailureofourprofessionalorganizationledtopsychologistsbeinginvolvedintorture.
• Becausewecanuseourtrainingandexpertisetorepairwhatwasdone.
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THANK YOU!!Adeyinka M. Akinsulure-Smith, Ph.D.
[email protected] Porterfield, [email protected]
Hawthorne Smith, [email protected]
Bellevue/NYU Program for Survivors of Torturehttp://www.survivorsoftorture.org/