Tuesday, May 05, 2009
Sunday, May 03, 2009
Testimonial Therapy: a brief intervention to improve wellbeing in Victim of torture.
Testimonial therapy originally was developed in Chile during the military dictatorship in 1970s. It has been successfully for the psychotherapeutic treatment for the women’s refugee who are survivor of sexual torture, and has also been a therapeutic tool employed within social frame of active human rights movement. Most recently principles of cognitive behavioral exposure therapy and testimony therapy have been combined in narrative exposure therapy for treatment of traumatized survivor of war and torture. Later in 2008 Testimonial therapy was introduced in India in pilot project of three month and Manual for community worker and human rights defender “Giving Voice” Using Testimony as a Brief Therapy Intervention in Psychosocial Community Work for Survivors of Torture and organized Violence was revised and finalize in October, 2008 by Dr. Inger Agger from Rehabilitation and Research Center for Torture Victim (RCT) and Dr. Lenin Raghuvanshi People’s Vigilance Committee on Human Rights (PVCHR).
Rehabilitation and Research Centre for Torture Victim (RCT) in collaboration with the Transcultural psychiatry, psychiatry centre Copenhagen University. Hospital/Rigshospitalet supported by the Danish Medical Research Council organized International Rehabilitation Conference on 3rd December, 08 to 5th December, 08 in Denmark.
So, on the first day of workshop Dr. Inger Agger PhD, Peter Polatin, M.D, MPH and Dr. Lenin Raghuvanshi, B.A.M.S presents Outcome Studies in TOV survivor in Testimonial Therapy: a brief intervention to improve wellbeing in Victim of torture.
Testimonial therapy provided through trained community worker and human rights activists, helps victim of torture to tell their stories, and to receive psychotherapeutic and community support. Justice is the entry point in the testimonial method.
It is hypothesized that public testimony about human rights violation within the context of testimonial therapy serves as: 1.) a cathartic and positive reframing experience for the survivors, 2.) desensitization and alternative learning from volitionally re-experiencing the trauma, and or 3.) gratification and empowerment by active contribution to obtaining justice and preventing torture in future.
While some mental health workers believe the process of taking about traumatic experiences alone can be helpful, the focus of testimonial therapy is on collaboration and documentation, with the intention to use the testimonial to educate an uninformed public and to advocate for justice. Human rights activists who normally work with testimonies as legal documentation are trained to add a psychological dimension to an activity with which they are already familiar. Therefore, Testimonial therapy offers advantage when mental health skills are in short supply and in communities suffering under extreme and frequent human rights violations.
A collaborative three month pilot project was undertaken between RCT and People’s Vigilance Committee on Human Rights (PVCHR) in Varanasi, India on “Testimony as a brief therapy intervention”. The project involves four weeks of training of PVCHR staff by a consultant who is expert in testimonial therapy, the development of context specific training manual, and the use of a monitoring and evaluation system for the purpose of outcome and evaluation comparing results of measures before the intervention and 2-3 month thereafter. Twelve community workers were trained to work in pair and to utilize testimonial therapy. Twenty three victims underwent treatment, under supervision. Most clients received 2 or 3 treatment sessions. Outcome measures issued were the WHO5, the pain analog, and a derived questionnaire utilizing ICF activity and participation categories.
The therapist allowed the survivors as much control over the story telling as possible, including the pace of the narrative and the amount of information shared. A transcript was created, and the testifier had a final say in its exact wording and eventual distribution. The therapist utilized the mindfulness and or other culturally appropriates meditative relaxation method to ensure that the testimonial process was not overwhelmingly distressing. A public delivery session was introduced, in which the survivor was honored after therapy (with consent), and the testimony read out and given to the survivor in a community ceremony.
The individuals who participated in this pilot study were mostly primary victims of torture. The perpetrators were almost always the police. Prior to participation in testimonial therapy, most of the participants were having difficulties functioning under stress. Many were able to work and support themselves with mind to moderate difficulty, but all had been doing better before they were tortured and had much more difficulty with income generating activities immediately after being tortured. Quite few had residual pain and, a low sense of well being. Many of them had three or more residual psychological symptom subsequent to the torture event. Many did not understand the issue of basic human rights or could not appropriately answer questions about issues related to politics and human rights. Most of them receive very low levels of health care after they had been tortured, although many of them had fairly extensive physical injuries. All had seen an attorney, reflection of the fact that they were involved with PVCHR.
After testimonial therapy all subjects demonstrated significant improvements in overall WHO 5 score. Four out of five individual item improved by atleast 40 %. ICF item showed less significant change, possibly because the question had not been well understood, but did never improve nevertheless.
The community ceremony component which was introduced into the project was observed to be quite dramatic in promoting improved subject demeanor. This would suggest a fourth hypothesis to explain the benefit of testimonial therapy: destigmatization and reintegration of the survivor into his family and community.
Testimonial Therapy as it has been developed in this project is both an individual and community based model, best adapted to a situation where work with the trauma has been delayed. The usual format is brief (3-4 sessions). In this very small pilot study, brief testimonial therapy appears to improve the well being of the subject who have completed treatment. However, a more extensive study is needed to verify these results, and better measures of ICF A & P function should be used.
