Therapeutic interventions with survivors of torture should explore the individual's vulnerabilities and risks, as well as strengths and protective factors. It is important to build a therapeutic alliance and understand clients within the broader context of their everyday lives.
The meanings that survivors of torture attribute to their past experience may vary. In the clinical context, it is important to consider the survivor's interpretation of torture when addressing it (C de C Williams & van der Merwe, 2013). Health care providers should interpret symptoms as understandable responses to adverse circumstances, and they should respect any descriptions or explanations that survivors offer of their experiences (e.g., references to karma or “God's will”). Health care professionals should “work within the client's frame of reference and seek to encourage recognition of their condition as a state which can be transformed” (Gorman, 2001, 446).
Survivors of torture may have a range of mental health and social difficulties that present as complex problems that may not easily fit into diagnostic categories (C de C Williams & van der Merwe, 2013). For example, Syrians who have experienced torture may have somatic complaints such as body pains or breathing problems. Simply labelling these complaints as somatization with the underlying assumption that the problem is psychological may be stigmatizing. On the other hand, providing a diagnosis without providing effective treatment could lead the survivor to somatic fixation or maladaptive coping. Instead, it may be more effective to refrain from diagnostic labelling and work with the client to minimize symptoms and improve functioning (Hassan et al., 2016).
Inform yourself and become knowledgeable about general issues connected with torture.
Inform yourself and become knowledgeable about the specific realities in particular countries.
Validate the survivor's story and allow for testimonial ventilation, regardless of the time elapsed since the torture took place.
Identify possible symptoms of illness or disorder and refer the survivor to appropriate professionals.
Extend the evaluation to the survivor's spouse, children and other family members.
Be careful about making assumptions or applying personal biases. Be aware that your first line of defense may be to simplify things so that you won't be disturbed or frightened by the discovery that phenomena associated with torture are the norm rather than the exception.
Don't feel that because the survivor appears to be functioning well and not having any special problems that they have fully recovered. In fact, the reintegration process can wax and wane. The fluctuating nature of the process allows for the survivor to achieve adaptation and ability functioning in some areas, while at the same time leaving other areas untouched.
Don't rush things or jump to conclusions, and don't offer more help than what is strictly necessary. Be available through empathetic understanding and in time, your availability will be greatly appreciated.
Don't consider the basic needs of a person who has been tortured as being different from the basic needs of any individual. However, do identify the special needs that arise out of the extreme situation survivors have lived through, as well as needs connected with being exiled as a refugee to another, unfamiliar, country.
There is an old saying in my country: “You have one mouth to speak but two ears to listen.” That means you need to listen more and not talk. We open up ourselves so that they can trust us. If there is no trust, if there is no rapport, they will not be sharing their experiences and it will be difficult for us to provide the services as well. I am talking to you now. I am the one who is doing the talking, but you are assessing me also without talking. So the interaction, the counselling process, is a two-way process as well. They are processing the information but at the same time also saying: “Can I trust this person? Can I share the information with this person? Is he or she genuinely interested to solve my problems?” So we are mindful of that. That's why we say they are agents of their own recovery. When they first come, what we do is we allow them to say whatever they want. There are people who come to the centre, who sit down at the reception and don't want to talk to anybody. So we allow them this. This is their place. This is a safe environment. Maybe they are assessing the environment to see if it's safe for them. Then the first entry point would be for them: “I need to learn English.” Even though some of them are very fluent in English, they want to assess further and when they see a large traffic going into the classroom, they say “I want the language classes.” But when we want to do the assessment, sometimes they even refuse to give us their address. So we allow them to observe in the classroom. Once they see who the audience is in the classroom, they are people who have more or less similar experiences, that's the time they start opening up. They come back to the counsellor and ask for more services. And at the same time we get more information from them as well. It's on an incremental basis, slowly.