Workshop on Testimonial Therapy

7/28/2019 Workshop on Testimonial Therapy

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FOR S U RVIVORS OF HU M A N RIG HTS

VIO LA TIO NSWOR KS HO P N OTES

LEN IN RA G HU VA N S HI, PVC HR

VA RA N A S I, I ND IA

&

IN G ER A G G ER, PHD , RC T

C OPEN HA G EN , D EN M A RK

The Testimony Method as a

Therapeutic Tool


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Survivor giving Testimony in Village


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Session 01: What is Testimony?

A double meaning in English

Objective, legal, public, official (evidence,attestation, proof)

Subjective, cathartic, spiritual, emotional, private(confession, expression of disapproval,condemnation, protestation)

To confess ritually to a socially accredited person or

publicly to the society

The subjective, private pain is seen in an objective,political context


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Session 01: History of Testimony Method

1983 Chile: For torture victims - to facilitateintegration of traumatic experience and restore self-esteem. Channels anger into socially constructiveaction document could be used against offender

1990 Denmark: For political refugees tortured intheir homeland a ritual of healing which isuniversally understood

1992 Netherlands: For refugees recommended as a

brief psychotherapy method 1994: Denmark: For women who had been sexually

abused during torture


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Session 01: History of Testimony Method

1996 Chile: As an important part of the HumanRights Movement

1998 South Africa: As part of Truth and

Reconciliation Commission Process connectionbetween individual healing and nationalreconciliation

1998 Bosnia: For refugees - led to improvement in

PTSD and depressive symptoms 2002 Kosovo: For refugees seen as a narrative

exposure treatment a cognitive method


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Session 01: History of Testimony

2003 Netherlands: For refugees seen as exposureto traumatic memories and adjustment ofinadequate thinking

2003 Germany: For traumatised Bosnian refugees feelings of self-esteem and dignity were regained

2004 Mozambique: For survivors of civil war in rurlacamps decrease os psychiatric symptoms

2004 Uganda: For Sudanese refugees in Ugandancamps Narrative Exposure Therapy had promisingresults for treatment of PTSD


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Session 01: History of Testimony

2004 USA: For adolescent Sudanese refugees anacceptable interaction bridging cultural gapspreventing refugees from seeking psychiatric help

2005 Iraq: For injured humanitarian workers afterbombing of UN HQ in Bagdad a safe structure torecall the traumatic event

2005 USA: For African Americans personal and

collective stories are told and the person is seenwithin the community

2008 Varanasi, India: For torture victims


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Session 01: Traumatic Stress

Any external event which has a profound effect onthe psychological state of a person: experiencing or

witnessing a life-threatening event

In response to threat people, like all animals,mobilize for automaticphysical action

Successful motor response (fight/flight/freeze)returns organism to homeostasis

Failed response (immobilization, helplessness, fear,horror) may result in a number of physical andpsychological symptoms


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Session 01: Traumatic Stress Symptoms

Reliving or re-experiencing of the traumatic event:nightmares or flashbacks in waking hours, sense of

being back in the traumatic situation

Avoidance of reminders of the traumatic event: (1)

active avoidance (avoiding people, places; avoidtalking or thinking about event); (2)passiveavoidance (general emotional numbing, no feelings,detachment from other people)

Hyper-arousal, alert, nervous: sleeping andconcentration difficulties, exaggerated startleresponse, constant feeling of threat


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Session 01: Traumatic Stress Symptoms

For a diagnosis of Post-Traumatic Stress Disorder(PTSD) these symptoms must have lasted for aminimum of 4 weeks

Severe problems in social, occupational or otherevery day functioning


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Session 01: Types of Stressor

War

Structural violence: the violence built into society

Repression: open or subtle, entire society or sub-

groups, physical, psychological and/or social Torture

Flight and refugee status Partly voluntary (fear)

Forced (ethnic cleansing)

Planned (secret) or unplanned (in panic)

Psychological sequels (sadness and mourning, guilt, anxiety)


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Session 01: Psychosocial Community Work

Goals

(1)Individual psychological and social healingthrough personal, group and environmental healing

(2) Community healing and empowerment byrestoring sense of security and organising ofcommunity members (meetings, folk schools)

(3) Community development by economic activity to

improve standard of living and welfare in thecommunity


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Stages

(1) Identification of relevant communities

(2) Assessment of needs (psycho-social, legal, health,education) through key informants, interviews, focus

groups, surveys (3) development of strategies, methods and materials for

community-based interventions Individual and/or group treatment (Testimony Method?)

Socio-educational groups Social action groups

Self-help support groups

Training of community members to become group leaders


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(4) Implementation

Enhancing protective factors such as:

1. extended family

2. cultural and religious practices

3. fight for human rights

4. giving testimony

5. empowering community members

(5) Monitoring and evaluation (M&E) ofimplementation


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Session 02: Meditation

Religious beliefs, prayers and pujas are importantcoping strategies in South Asia (Sonpar, 2008)

Yoga, meditaton, pranayama, ayurveda Chanting, slokas, vipassana meditation, telling

beads, practicing yoga were found to be readilyaccepted and beneficial in Sri Lanka and India?

(Somasundaram, 2007)


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Session 02: Meditation Instruction

Placing your feet flat on the floor

Lengthening your back up through the top of yourhead

Bringing your attention to the navel area of yourstomach

Bringing your attention to your breathing

Noticing how your stomach moves in and out

When thoughts come, notice them, let them go byand bring your attention back to your breath

Remaining in this position for ten minutes


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Session 02: Active Listening (1)

Open questions (examples)

- What can I do for you?

- What do you mean by that?

What happened to you? - Tell me something about yourself?


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Closed questions (examples):

- What is your name?

- How old are you?

- What is your address?


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Repetition of small phrases:

- A: Tell me something about yourself?

- B: I come from Varanasi

- A: Varanasi? - B: Yes, from the Holy City. I lived there until I was

seventeen and then I moved to New Delhi to go touniversity

- A: You went to university in New Delhi?

- B: Yes, to the social work faculty


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Exercise (1)

- A: In twos, take 5 minutes each to tell one anotherabout an experience you have strong emotions about

- B: Evaluate how the person asking the questionsfelt and how the person telling the story felt


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- Give summaries during the conversation

- Reflect both the information and the feelings thatgo with it

Example:

If I understand you correctly you have been sick forthe last 3 days and have a headache, a runny nose,and muscle pain. The illness is so bad that you haveto go to bed, and, because of that, you cannot takecare of your children and you feel bad about that


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Exercise (2) In other groups of two, let each person talk about 5

minutes to tell something about him/herself. Thelistener should use the techniques of active listening:

- Open questions

- Repetition of small phrases

- Summaries of facts and feelings

Evaluate how the listener and the person telling thestory felt


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Non-verbal behaviour

- Look at the person with sufficient but not excessiveeye contact

Feelthe interest in the other person Show in the posture of your body that you are

interested in the other person


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Silence

Do not be afraid of silences in the conversation

- Give the other person an adequate (for you maybe)

long time to react to what you have asked him/her - The other person may need time to think or to react

in an emotional way

- If you jump too quickly, you may impede theprocess


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In groups of two each person finds a trauma in his orher own life

Use the rules of communication and active listening

to describe the trauma (10 minutes each) Open questions

Repetition of small phrases

Summaries of facts and feelings

Non-verbal behaviour Evaluate the trauma stories and identify some of the

reactions mentioned


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Testimony is read at Community Meeting


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Session 03: Procedures for Taking Testimony

How is the Testimony taken?

Session one : Opening the story

Session two: Closing the story

Session three: The delivery ceremony Session four: Follow-up


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Session 03: The M&E Questionnaire

Why do M&E?

The contents of the questionnaire

Session One: filling in of questionnaire

1. History and demographic questionnaire2. Evaluation and questionnaire

Session Two: filing in of questionnaire

Post testimony assessment of trauma Session Four: filling in of questionnaire

To be done one month after the delivery ceremony


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Session 3: M&E

Session four: Post-therapy meeting to evaluate outcome of testimonytherapy

The therapists meet with the survivor one to two months after thelast intervention (public ceremony, community meeting, or deliveryof the testimony), and the M&E questionnaire is filled-in;

The results of the tests are entered into the database;

An analysis of the results is made;

The results are evaluated and recommendations are made aboutfuture work with the testimony method.


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Session 04: Meditation

Placing your feet flat on the floor Lengthening your back up through the top of your

head

Bringing your attention to the navel area of yourstomach

Bringing your attention to your breathing

Noticing how your stomach moves in and out

When thoughts come, notice them, let them go byand bring your attention back to your breath

Remaining in this position for ten minutes


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Session 04: Communication Exercises

Using the M&E questionnaire:

(1) In pairs take turns filling in the M&E questionnaire

(2) You can either be yourself or play the role of avictims you know

(3) Group discussion of experiences and problemsencountered


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Healing elements of the Testimony Method

Survivors regain self-esteem and dignity by recording their story in a human rights context: theprivate pain is reframed and takes on a political meaning;

Stressful events are integrated by helping the survivor to reconstruct the fragmented story sothat it becomes a coherent narrative, which is balanced and contains both hard and softelements of the story;

Survivors are exposed to the fear experienced during the stressful event. Re-experiencing thisfear in a safe, supportive and meaningful context can help the survivors understand theirpresent emotional reactions and diminish anxiety and stress reactions;

Survivors understand how present thoughts and responses have developed and how certainsituations (e.g. seeing a policeman) might trigger the fear response;

By adding a mindfulness meditation component to the testimony method, stress and anxiety isfurther reduced, and awareness about harmful and healing thoughts is encouraged. Moreover,meditation is an important part of Indian tradition.


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When is testimony Therapy Needed?

When a legal testimony is taken for use in court proceedings, the community worker or humanrights defender may notice that a survivor is suffering from serious psychosocial and emotionalproblems. In this case, it might be relevant to refer the survivor for testimony therapy.

The survivors referred for testimony therapy must be men and women who are more thanfourteen years old;

The survivors can be primary or secondary victims of TOV. Often the secondary victims arefemale and have been beaten and abused by the police while the primary victims were arrested.Often they are more psychologically affected than the primary victims;

Referral is notadvised if: The survivor suffers from severe depression or other psychotic symptoms. In this case, the

survivor should be referred to a psychiatrist; If the survivor is active in a self-healing process of political or human rights activism; If the survivor is not motivated for therapy. A staff member with a medical, psychological or social work background should evaluate

referrals for testimony therapy and pass the referrals on to trained community workers orhuman rights defenders.


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Who Takes the Testimonies?

It is only possible to use the testimony method with survivors of torture if they have a complete trustin the therapists.Therefore, the therapists must be part of an organisation, which the survivors already know and in which they have faith. This

will most likely be a human rights organisation, which has already made legal testimonies with the survivors and supportedthem in their fight for legal justice and reparation.

The testimony therapy is performed bytwopersons (therapists), with one acting primarily as the interviewer, while the otheris the note-taker. They act as co-therapists, supporting each other in the elaboration of the testimony.

The therapists can be community workers, human rights defenders on the grassroots level, or social workers based in a centrallocation. Therapists should have the minimum of a high school education, plus three years of field experience. All must have

been trained in testimony therapy.

For testimonies with female survivors, the therapists (and possibly interpreter) should be female. Usually therapists of bothgenders can take testimonies with male survivors except for cases of sexual torture.

In some parts of India, an interpreter may be required, who - in that case must also be trained in the testimony method.

The therapists must come from another village than the survivor.

The testimony should be taken in a secluded place, which is chosen by the survivor. It might be in the home of the survivor or ina community centre..


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The testimony therapy is performed over four sessions including a monitoring andevaluation (M&E) element. M&E is advisable and requires pre and post therapyassessments in which a questionnaire is completed. M&E is helpful to more clearlyidentify socio-demographic, psychosocial, and health characteristics of thesurvivors. With a pre therapy assessment, a baseline is also established which can becompared to post intervention levels of functioning.

Duration of sessions: 90 120 minutes. The survivor should be informed before thesession starts about the number and duration of sessions;

Meditation: First and second session includes a meditation (mindfulness)experience guided by the therapists, in which the survivor and the two therapists sittogether for ten minutes in silent concentration on their breathing and withawareness of their thoughts and feelings. The meditation will usually take place at

the end of a session.

The results of this comparison are valuable for raising awareness about theimportance of investigating the outcome of psychosocial interventions. Thisawareness can lead to improvements of the methodology. However, without controlgroups, the effect of the method cannot be measured with full scientific validity.


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Writing the story: The testimony is written in note form by thenote-taker during the sessions; After the sessions, theinterviewer and note-taker collaborate on filling-in themissing parts of the story and produce a computer version ofthe narrative;

Grammar of the story: The story in the written testimony is inthe first person (I experienced, and not he experienced).The story about the traumatic events is in the past tense, whilesensations and feelings produced by the story are in thepresent tense;

Peer support: Therapist should organise settings where they

can support and supervise each other. This could be in groupsor in pairs. Working with survivors of TOV is stressful foreverybody.


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Session O6: Session One

Session one: The testimony procedure is explained, beginning with a psycho-educational introduction to the

survivor in which his or her symptoms are explained both as a result of the torture and of theviolation of universal human rights, which has taken place.

Preparatory introduction to the therapeutic approach: the testimony should not be seen by thesurvivor as directly related to expectations of obtaining immediate justice and reparation but asa way of healing the psychological effects of the torture.

The M&E questionnaire is completed: It is explained that the data are confidential and will onlybe used for developing methods for helping survivors of torture;

Short description of personal background and individual history prior to the first traumaticevent or persecution;

With open questions the survivor is asked to briefly describe the stressful events s/he hasexperienced and choose one major, overwhelming traumatic event;

The therapist gives an overview of the different events to help the survivor trace one of theexperiences and help him/her really begin the re-construction of the narrative;


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Session 06: Session One

The therapist separates overlapping stories (if the survivor wants to tell about more than oneevent); the therapist structures the topics and helps to clarify ambiguous descriptions;

It is important that the therapist is in control of the situation and leads the survivor in gettingto the main points of the story;

The survivor narrates the facts concerning this event (time, place, duration and peopleinvolved); the survivors role during the event (observer, participant, active or passive); the

individual and social dimensions of the experience; the survivors perceptions and feelings atthe time of the event; the survivors perceptions and feelings at the time of the testimonytherapy;

The therapists (interviewer and note-taker) are empathic and accepting; Inconsistencies aregently pointed out; the survivor is encouraged to describe the traumatic events in as muchdetail as possible and to reveal the emotions and perceptions experienced at that moment;

Culturally appropriate touch (e.g. a hand on the arm of the survivor) may be used by thetherapist as a healing tool;

A mindfulness meditation experience is conducted at the end of the session.


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In groups of three: One interviewer, one note-takerand one survivor begin taking a testimony (sessionone: opening the story, including the M&E )

After 20 minutes change roles After 20 change roles


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Group discussion with feed back from the differentgroups


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Session 07: Session Two

Session two: One of the therapists starts the session by reading the written testimony to the

survivor in a loud voice so that the survivor hears that his or her story has beengiven voice. The survivor is asked to correct the story or add any additional detailsthat may have been missed;

The therapists continues the session as during the first session;

The therapists focus especially on the relationship between the stressful experienceand the present situation;

The survivor is encouraged to express his or her feelings about the future(individual, family and community);

A mindfulness meditation experience is conducted at the end of the session;

After the session, the therapists correct the document and a final version of thetestimony is produced.


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In groups of three: One interviewer, one note-takerand one survivor begin taking a testimony (sessiontwo: closing the story, including reading the story tothe survivor)

After 20 minutes change roles

After 20 change role


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Group discussion with feed back from the differentgroups


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Session 09: Session Three - Ceremony

Session three: The Ceremony (the turning point) The corrected document is read out to the survivor and signed by survivor and the therapists,

and the document is handed over to the survivor. The final version of the testimony is producedin a form that is as appealing and beautiful as possible (e.g. on good paper, bound and with anice front page including a photo of the survivor). The delivery can take place at a publicceremony if the survivor agrees (e.g. in front of the court)

Using the survivors testimony at a public meeting is a powerful way of giving voice to the

oppressed, and might be a turning point in the healing process;

If a public ceremony is held, possibly including the testimonies of several survivors, the humanrights organisation can give the survivor recognition, and pay tribute to the importance of thetestimony, which now has the significance of a memorial. The survivors may receive honoraryflower garlands and shawls, and the media as well as public dignitaries (including the police)might be invited to attend the ceremony;

The testimony can also be read out by the therapists at a community meeting where the groupand the survivor can comment and supplement it and the survivor can get the support of theother group members. Also here the human rights organisation pays tribute to the bravery andstruggle of the survivor. Up to four or five testimonies can be read out during the same meeting;

The community meeting is concluded by a meditation experience.


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Honour Ceremony for Survivor


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Session 09: Session Three

Delivery ceremony

The whole group plays the role of a communitymeeting where a testimony is delivered to asurvivor. One of the groups of three from theprevious role plays the roles of interviewer, note-taker and survivor


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Session 09 : Use of Testimony

The use of the testimony A copy of the testimony is kept for documentation purposes if

the survivor agrees;

The testimony can serve as a memorial to inform and teach

future generations (e.g. a grandchild may read out thetestimony to the survivor);

The testimony may also be used for advocacy purposes, legalaction or published in some other way if the survivor agrees

and if it can be assured that no harm may result for thesurvivor; the testimony can also be translated into English soas to maximize its potential to be used to further the work ofinternational human rights advocacy;


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Session 09: Testimony Procedures

Recapitulation of the four stages in the TestimonyMethod

Opening the story

Closing the story The delivery ceremony

The follow-up


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Session 10: Taking Care of Care Takers

It is impossible not to be affected by the traumastories you are confronted with

It is important to be aware of and to reflect on thereactions you have

Only with this distance: technical neutrality youare useful to the people you want to help

Moral neutrality is something different. Youcannot be morally neutral towards human rights

violations You can deal with you own reactions both within a

group or individually


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Session 10: Taking Care of the Care-Takers

Group discussion

Discuss the ways each of you deal with your ownreactions using the techniques of active listening

Find ways to improve possibilities for supportingyourself and your members of the team


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Session 10: Planning of Field Work

Concrete planning of next weeks field work andsupervision.


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Session 10: Closing Discussion

Summing up and final discussion of challenges andusefulness of the Testimony Method

Documents

Workshop on Testimonial Therapy