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IV. GENERAL CONSIDERATIONS FOR INTERVIEWS ISTANBUL PROTOCOL

defences that result in profound withdrawal and communication, empathy and by allowing individuals
affective flattening during examination or interview; control over their narrative account of the alleged
alternatively, they may express hostility and anger. events. Applying these and other essential interview
Retraumatization presents special difficulties because skills are of paramount importance in conducting an
torture victims may be unable to communicate their effective interview and in avoiding retraumatizing
trauma history and related sequelae, although it a torture survivor. Despite efforts to prevent and
would be beneficial for them to do so. Symptoms of mitigate retraumatization, torture survivors are
retraumatization may be present during the interview likely to experience some level of distress during
or affect the survivor for days and even weeks after a clinical interview. Clinicians, together with the
the interview and examination. In addition, those individual, should balance the potential traumatic
who survive torture and remain in their country may effects of an interview with the potential benefits
experience intense fear and suspicion about being of a comprehensive medico-legal evaluation. When
rearrested and they may feel forced to go into hiding. the interviewer suspects that retraumatization has
occurred, it would be important to acknowledge the
278. Interviews, examinations and diagnostic testing concern, mitigate ongoing retraumatization (such as
may also exacerbate psychological sequelae in with breaks, breathing exercises and redirection to
torture survivors. The interview can trigger new less emotional topics), offer psychological support and
or worsening symptoms of post-traumatic stress refer the alleged victim to appropriate follow-up care.
such as: (a) symptoms of physical pain or anxiety;
(b) re-experiencing of the traumatic event (e.g. 5. Gender, sexual orientation and gender identity
flashbacks); (c) avoiding reminders associated with
the trauma; (d) numbing of general responsiveness; 281. Both victims and perpetrators of torture or
(e) insomnia and sleep-related phenomena; and ill-treatment can be of any sexual orientation or gender
(f) feelings of fear, shame and guilt. Symptoms of and, though often discussed together, sex, gender and
depression and anxiety may also worsen during sexual orientation are each different from one another.
and after the interview and examination. Because Sexual orientation refers to inherent emotional,
exacerbation of these symptoms may worsen suicidal romantic and/or sexual attraction to other people.
thoughts, clinicians should consider reassessing the Gender identity refers to how individuals perceive
risk of self-harm when relevant. Clinicians should themselves and what they call themselves. Individuals
also be aware that questions about psychological who self-identify with any from a wide and varied
distress are sometimes considered taboo in many spectrum of non-heterosexual orientations are often
traditional societies and the asking of such questions referred to as lesbian, gay, bisexual, transgender and
can be regarded as irreverent or insulting. queer persons. Intersex persons are those who are born
with sex characteristics (including genitals, gonads and
279. The torture survivor’s personal reactions to the chromosome patterns) that do not fit typical binary
interviewer (and the interpreter, in cases in which notions of male or female bodies. These individuals, as
one is used) can impact the interview process and, well as those who find themselves in the process of
in turn, the outcome of the evaluation. Likewise, the questioning, exploring or beginning to understand their
personal reactions of the interviewer towards the sexual orientation, are all at increased risk of torture
interviewee can also affect the process of the interview and ill-treatment. In cases in which the alleged
and the outcome of the evaluation. It is important victims do not conform to the traditional binary
to examine the barriers to effective communication, notion of gender (including transgender, intersex
including the implicit and explicit bias of the clinician, and gender non-conforming persons), interviewers
and the influence that these personal reactions should acknowledge the stated gender identity of
might have on an evaluation. The clinician should interviewees and use their preferred name and gender
maintain awareness of such factors through an pronouns accordingly (see paras. 599–601 below).
ongoing examination of the interview and evaluation
process. Consultation and discussion with colleagues 282. It is important to differentiate between sexual and
familiar with the field of psychological assessment gender-based torture and abuse. Sexual torture
and treatment of torture survivors may be helpful. includes verbal, emotional and physical acts of
a sexual nature with the intention of producing
280. Examiners can prevent and mitigate retraumatization physical and psychological suffering. In gender-
and psychological sequelae with effective based torture, the gender identity and/or sexual

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