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VI. PSYCHOLOGICAL EVIDENCE OF TORTURE AND ILL-TREATMENT ISTANBUL PROTOCOL

cultural background. It is inappropriate to observe (a) History of torture and ill-treatment
the strict “clinical neutrality” that is used in some
forms of psychotherapy, during which the clinician 529. Every effort should be made to document the full
is inactive and says little. The clinician should history of the alleged torture or ill-treatment and other
communicate in a transparent and empathic way relevant traumatic experiences as stated by the alleged
and adopt a supportive, non-judgmental approach. victim (see paras. 364–372 above). This part of the
evaluation is often exhausting for the person being
2. Interview process evaluated. Therefore, it may be necessary to proceed
in several sessions. The interview should start with a
526. Clinicians should present themselves and introduce general summary of events before eliciting the details
the purpose and process of the interview in a manner of the alleged torture or ill-treatment experience. The
that explains in detail the procedures to be followed interviewer needs to know the legal issues at hand
and the topics to be addressed and that prepares the because that will determine the nature and amount
individual for the difficult emotional reactions that of information necessary to achieve a comprehensive
the questions may provoke. Clinicians need to be documentation of alleged torture or ill-treatment.
sensitive and empathetic in their questioning, while
remaining objective in their clinical assessment. At (b) Current psychological complaints
all times they have to balance their need to obtain
detailed information and the needs of the alleged 530. An assessment of the current psychological condition
victims to maintain or regain their emotional and complaints constitutes the core of the evaluation.
balance. Interviews must be conducted in a way In addition to the spontaneous description of the
that reduces the risk of retraumatization and, at all interviewee, specific questions regarding common
times, allows the alleged victim to maintain a sense psychological responses to torture (as described
of control. Chapter IV describes comprehensive in paras. 499–522) should be asked. All affective,
guidelines for conducting clinical interviews. cognitive and behavioural symptoms should be
described in detail, including their severity, frequency,
527. An appropriate structuring of the clinical interview onset and evolution over time, regardless of whether
is fundamental in building adequate rapport and they amount to a specific diagnosis. It is important
trust. Generally, it is advisable to start the interview to give a detailed description of the specific symptom
with less sensitive issues and then proceed to more presentation as this helps to substantiate the level
difficult or stressful content. In many cases, it of consistency between the alleged torture or
might be useful to start with the pre-torture history ill-treatment and the psychological findings at a later
and follow a chronological order. In other cases, stage. This may include the description of the content
especially when the person is under a high level of of nightmares, recurrent thoughts or memories,
emotional distress, it may be better to start with the flashbacks or hallucinations. Triggers for emotional
current psychological complaints and current social distress, sadness, fear or reliving experiences should
functioning. The clinician is advised to use a flexible also be explored and described. Questions about sleep
approach instead of following a predetermined (how many hours, what interrupts sleep, feelings
order. The following description of the components when waking up from a nightmare), of how the day
of the psychological/psychiatric evaluation follows is spent (in social isolation, trying to keep busy at all
the suggested order for the written report (see costs, obsessive/compulsive behaviours and the ability
annex IV), but not for the clinical interview. to carry out the activities involved in daily living),
as well as questions to identify avoidance behaviour
3. Components of the psychological/psychiatric related to triggers for re-experience should be asked.
evaluation An absence or subthreshold level of symptoms at
the time of assessment can be due to the episodic
528. The introduction should contain mention of the nature or delayed onset of specific symptoms or to
referral source, a summary of collateral sources denial of symptoms because of shame. Therefore, the
(such as medical, legal and psychiatric records) exploration and assessment of the symptom evolution
and a description of the methods of assessment since the alleged torture is of paramount importance.
used (e.g. interviews, symptom inventories,
checklists and neuropsychological testing).

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