The Testimony Method as a Therapeutic Tool

FOR SURVIVORS OF HUMAN RIGHTS VIOLATIONS WORKSHOP NOTES LENIN RAGHUVANSHI, PVCHR VARANASI, INDIA & INGER AGGER, PHD, RCT COPENHAGEN, DENMARK

Survivor giving Testimony in Village

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

Session 01: History of Testimony Method

1983 Chile: For torture victims - to facilitate

integration of traumatic experience and restore selfesteem. Channels anger into socially constructive action document could be used against offender 1990 Denmark: For political refugees tortured in their homeland a ritual of healing which is universally understood 1992 Netherlands: For refugees recommended as a brief psychotherapy method 1994: Denmark: For women who had been sexually abused during torture

Session 01: History of Testimony Method

1996 Chile: As an important part of the Human

Rights Movement 1998 South Africa: As part of Truth and Reconciliation Commission Process connection between individual healing and national reconciliation 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

Session 01: History of Testimony

2003 Netherlands: For refugees seen as exposure

to traumatic memories and adjustment of inadequate thinking 2003 Germany: For traumatised Bosnian refugees feelings of self-esteem and dignity were regained 2004 Mozambique: For survivors of civil war in rurla camps decrease os psychiatric symptoms 2004 Uganda: For Sudanese refugees in Ugandan camps Narrative Exposure Therapy had promising results for treatment of PTSD

Session 01: History of Testimony

2004 USA: For adolescent Sudanese refugees an

acceptable interaction bridging cultural gaps preventing refugees from seeking psychiatric help 2005 Iraq: For injured humanitarian workers after bombing of UN HQ in Bagdad a safe structure to recall the traumatic event 2005 USA: For African Americans personal and collective stories are told and the person is seen within the community 2008 Varanasi, India: For torture victims

Session 01: Traumatic Stress

Any external event which has a profound effect on

the psychological state of a person: experiencing or witnessing a life-threatening event In response to threat people, like all animals, mobilize for automatic physical action Successful motor response (fight/flight/freeze) returns organism to homeostasis Failed response (immobilization, helplessness, fear, horror) may result in a number of physical and psychological symptoms

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; avoid talking or thinking about event); (2) passive avoidance (general emotional numbing, no feelings, detachment from other people) Hyper-arousal, alert, nervous: sleeping and concentration difficulties, exaggerated startle response, constant feeling of threat

Session 01: Traumatic Stress Symptoms

For a diagnosis of Post-Traumatic Stress Disorder

(PTSD) these symptoms must have lasted for a minimum of 4 weeks Severe problems in social, occupational or other every day functioning

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)

Session 01: Psychosocial Community Work

Goals (1) Individual psychological and social healing through personal, group and environmental healing (2) Community healing and empowerment by restoring sense of security and organising of community members (meetings, folk schools) (3) Community development by economic activity to improve standard of living and welfare in the community

Session 01: Psychosocial Community Work

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

Session 01: Psychosocial Community Work

(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) of

implementation

Session 02: Meditation

Religious beliefs, prayers and pujas are important

coping strategies in South Asia (Sonpar, 2008) Yoga, meditaton, pranayama, ayurveda Chanting, slokas, vipassana meditation, telling beads, practicing yoga were found to be readily accepted and beneficial in Sri Lanka and India? (Somasundaram, 2007)

Session 02: Meditation Instruction

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 your stomach Bringing your attention to your breathing Noticing how your stomach moves in and out When thoughts come, notice them, let them go by and bring your attention back to your breath Remaining in this position for ten minutes

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?

Session 02: Active Listening (1)

Closed questions (examples): - What is your name? - How old are you? - What is your address?

Session 02: Active Listening (1)

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 to university - A: You went to university in New Delhi? - B: Yes, to the social work faculty

Session 02: Active Listening (1)

Exercise (1) - A: In twos, take 5 minutes each to tell one another about an experience you have strong emotions about - B: Evaluate how the person asking the questions felt and how the person telling the story felt

Session 02: Active Listening (2)

- Give summaries during the conversation - Reflect both the information and the feelings that

go with it Example: If I understand you correctly you have been sick for the last 3 days and have a headache, a runny nose, and muscle pain. The illness is so bad that you have to go to bed, and, because of that, you cannot take care of your children and you feel bad about that

Session 02: Active Listening (2)

Exercise (2) In other groups of two, let each person talk about 5 minutes to tell something about him/herself. The listener 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 the

story felt

Session 02: Active Listening (3)

Non-verbal behaviour - Look at the person with sufficient but not excessive eye contact Feel the interest in the other person Show in the posture of your body that you are interested in the other person

Session 02: Active Listening (3)

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 the process

Session 02: Active Listening (3)

In groups of two each person finds a trauma in his or

her 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

Testimony is read at Community Meeting

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

Session 03: The M&E Questionnaire

Why do M&E? The contents of the questionnaire Session One: filling in of questionnaire

History and demographic questionnaire 2. 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
1.

Session 3: M&E
Session four: Post-therapy meeting to evaluate outcome of testimony therapy
The therapists meet with the survivor one to two months after the

last intervention (public ceremony, community meeting, or delivery of 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 about

future work with the testimony method.

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 your stomach Bringing your attention to your breathing Noticing how your stomach moves in and out When thoughts come, notice them, let them go by and bring your attention back to your breath Remaining in this position for ten minutes

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 a victims you know (3) Group discussion of experiences and problems encountered

Session 05: Procedures for Taking Testimony

Healing elements of the Testimony Method

Survivors regain self-esteem and dignity by recording their story in a human rights context: the private pain is reframed and takes on a political meaning; Stressful events are integrated by helping the survivor to reconstruct the fragmented story so that it becomes a coherent narrative, which is balanced and contains both hard and soft elements of the story; Survivors are exposed to the fear experienced during the stressful event. Re-experiencing this fear in a safe, supportive and meaningful context can help the survivors understand their present emotional reactions and diminish anxiety and stress reactions;

Survivors understand how present thoughts and responses have developed and how certain situations (e.g. seeing a policeman) might trigger the fear response;
By adding a mindfulness meditation component to the testimony method, stress and anxiety is further reduced, and awareness about harmful and healing thoughts is encouraged. Moreover, meditation is an important part of Indian tradition.

Session 05: Procedures for Taking Testimony

When is testimony Therapy Needed?

When a legal testimony is taken for use in court proceedings, the community worker or human rights defender may notice that a survivor is suffering from serious psychosocial and emotional problems. 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 than fourteen years old;
The survivors can be primary or secondary victims of TOV. Often the secondary victims are female 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 not advised 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 or human rights defenders.

Session 05: Procedures for Taking Testimony

Who Takes the Testimonies?

It is only possible to use the testimony method with survivors of torture if they have a complete trust in 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 supported them in their fight for legal justice and reparation. The testimony therapy is performed by two persons (therapists), with one acting primarily as the interviewer, while the other is 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 central location. 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 both genders 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 in a community centre..

Session 05: Procedures for Taking Testimony

The testimony therapy is performed over four sessions including a monitoring and

evaluation (M&E) element. M&E is advisable and requires pre and post therapy assessments in which a questionnaire is completed. M&E is helpful to more clearly identify socio-demographic, psychosocial, and health characteristics of the survivors. With a pre therapy assessment, a baseline is also established which can be compared to post intervention levels of functioning. session starts about the number and duration of sessions;

Duration of sessions: 90 120 minutes. The survivor should be informed before the

Meditation: First and second session includes a meditation (mindfulness)

experience guided by the therapists, in which the survivor and the two therapists sit together for ten minutes in silent concentration on their breathing and with awareness of their thoughts and feelings. The meditation will usually take place at the end of a session. importance of investigating the outcome of psychosocial interventions. This awareness can lead to improvements of the methodology. However, without control groups, the effect of the method cannot be measured with full scientific validity.

The results of this comparison are valuable for raising awareness about the

Session 05: Procedures for Taking Testimony

Writing the story: The testimony is written in note form by the

note-taker during the sessions; After the sessions, the interviewer and note-taker collaborate on filling-in the missing parts of the story and produce a computer version of the narrative; Grammar of the story: The story in the written testimony is in the first person (I experienced, and not he experienced). The story about the traumatic events is in the past tense, while sensations and feelings produced by the story are in the present tense; Peer support: Therapist should organise settings where they can support and supervise each other. This could be in groups or in pairs. Working with survivors of TOV is stressful for everybody.

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 the violation of universal human rights, which has taken place.

Preparatory introduction to the therapeutic approach: the testimony should not be seen by the survivor as directly related to expectations of obtaining immediate justice and reparation but as a 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 only be used for developing methods for helping survivors of torture; Short description of personal background and individual history prior to the first traumatic event or persecution; With open questions the survivor is asked to briefly describe the stressful events s/he has experienced and choose one major, overwhelming traumatic event; The therapist gives an overview of the different events to help the survivor trace one of the experiences and help him/her really begin the re-construction of the narrative;

Session 06: Session One

The therapist separates overlapping stories (if the survivor wants to tell about more than one event); 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 getting to the main points of the story;

The survivor narrates the facts concerning this event (time, place, duration and people involved); the survivors role during the event (observer, participant, active or passive); the individual and social dimensions of the experience; the survivors perceptions and feelings at the time of the event; the survivors perceptions and feelings at the time of the testimony therapy;
The therapists (interviewer and note-taker) are empathic and accepting; Inconsistencies are gently pointed out; the survivor is encouraged to describe the traumatic events in as much detail 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 the therapist as a healing tool; A mindfulness meditation experience is conducted at the end of the session.

Session 06: Session One

In groups of three: One interviewer, one note-taker

and one survivor begin taking a testimony (session one: opening the story, including the M&E ) After 20 minutes change roles After 20 change roles

Session 06: Session One

Group discussion with feed back from the different

groups

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 been given voice. The survivor is asked to correct the story or add any additional details that may have been missed;
The therapists continues the session as during the first session;
The therapists focus especially on the relationship between the stressful experience

and 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 the

testimony is produced.

Session 08: Session Two

In groups of three: One interviewer, one note-taker

and one survivor begin taking a testimony (session two: closing the story, including reading the story to the survivor) After 20 minutes change roles After 20 change role

Session 08: Session Two

Group discussion with feed back from the different

groups

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 produced in a form that is as appealing and beautiful as possible (e.g. on good paper, bound and with a nice front page including a photo of the survivor). The delivery can take place at a public ceremony 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 human rights organisation can give the survivor recognition, and pay tribute to the importance of the testimony, which now has the significance of a memorial. The survivors may receive honorary flower 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 group and the survivor can comment and supplement it and the survivor can get the support of the other group members. Also here the human rights organisation pays tribute to the bravery and struggle 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.

Honour Ceremony for Survivor

Session 09: Session Three

Delivery ceremony The whole group plays the role of a community meeting where a testimony is delivered to a survivor. One of the groups of three from the previous role plays the roles of interviewer, notetaker and survivor

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 the testimony to the survivor);

The testimony may also be used for advocacy purposes, legal

action or published in some other way if the survivor agrees and if it can be assured that no harm may result for the survivor; the testimony can also be translated into English so as to maximize its potential to be used to further the work of international human rights advocacy;

Session 09: Testimony Procedures

Recapitulation of the four stages in the Testimony Method Opening the story Closing the story The delivery ceremony The follow-up

Session 10: Taking Care of Care Takers

It is impossible not to be affected by the trauma

stories you are confronted with It is important to be aware of and to reflect on the reactions you have Only with this distance: technical neutrality you are useful to the people you want to help Moral neutrality is something different. You cannot be morally neutral towards human rights violations You can deal with you own reactions both within a group or individually

Session 10: Taking Care of the Care-Takers

Group discussion Discuss the ways each of you deal with your own reactions using the techniques of active listening Find ways to improve possibilities for supporting yourself and your members of the team

Session 10: Planning of Field Work

Concrete planning of next weeks field work and supervision.

Session 10: Closing Discussion

Summing up and final discussion of challenges and

usefulness of the Testimony Method