first pilot project of pvchr-rct for testimonial therapy

7/28/2019 First pilot project of PVCHR-RCT for testimonial Therapy

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Giving Voice

Using Testimony as a Brief Therapy Intervention inPsychosocial Community Workfor Survivors of Torture and Organised Violence

Report from a Pilot Training Project with:

Peoples Vigilance Committee for Human Rights (PVCHR)Varanasi, India

Phase One of the Capacity Building Project:

Brief Therapy Interventions

Among Human Rights OrganisationsIn Crisis Affected or Developing Countries

Draft Final Report

July 2008

Inger Agger, PhDRehabilitation and Research Centrefor Victims of Torture (RCT),Copenhagen, Denmark


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Table of Contents

ABBREVIATIONS ................................................................................................................... 4

EXECUTIVE SUMMARY ....................................................................................................... 5

1. CHOICEOF TESTIMONY METHOD........................................................................................ 5

2. PROJECT OUTPUTS................................................................................................................ 5

3. THE M&E COMPONENT........................................................................................................ 6

1. INTRODUCTION ................................................................................................................. 7

2. DEVELOPMENT OF THE TESTIMONY METHOD ..................................................... 9

2.1 ADDING MINDFULNESS TOTHE TESTIMONY METHOD............................................... 12

3. THE WORKSHOP ............................................................................................................. 14

3.1 CONTENTOF WORKSHOP.................................................................................................. 14

3.2 WORKSHOP PARTICIPANTS............................................................................................... 17

3.3 THE TWENTY-THREE SURVIVORSWHOGAVETHEIR TESTIMONIES..............................18

3.4 THE DELIVERY CEREMONYANDPOLITICALDEMONSTRATION.....................................19

3.5 DEVELOPINGTHE MANUAL............................................................................................... 19

4. REVIEW OF THE M&E COMPONENT BY PETER POLATIN, MD, HEALTH

PROGRAM MANAGER ....................................................................................................... 20

4.1 ASSESSMENTOF M&E QUESTIONNAIRE: PROBLEMSTOBEREMEDIED........................ 20

4.2 PRELIMINARY STATISTICAL DATA GENERATED............................................................. 22

4.3 PRELIMINARY CONCLUSIONS BASEDON INITIAL EVALUATIONOFTHE M&E.............23

4.4 CONCLUSIONSAND RECOMMENDATIONS......................................................................... 24

ANNEX I. TERMS OF REFERENCE ................................................................................. 26

ANNEX II. MEMORANDUM OF UNDERSTANDING .................................................... 30

ANNEX III. M&E METHODOLOGY, BY PETER POLATIN, MD. HEALTHPROGRAM MANAGER ....................................................................................................... 34

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ANNEX IV. PILOT QUESTIONNAIRE, BY PETER POLATIN, MD, HEALTH

PROGRAM MANAGER ....................................................................................................... 38

ANNEX V. PROPOSAL FOR FURTHER COLLABORATION PVCHR/RCT ............. 43

ANNEX VI. PVCHR PRESS ANNOUNCEMENT ABOUT WORKSHOP,

CEREMONY AND DEMONSTRATION ........................................................................... 45

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Abbreviations

ICF International Classification of Functioning and Disability

MBCT Mindfulness-based Cognitive Therapy

MBSR Mindfulness-based Stress Reduction

M&E Monitoring and Evaluation

NET Narrative Exposure Therapy

PTSD Post-traumatic Stress Disorder

PVCHR Peoples Vigilance Committee on Human Rights

RCT Rehabilitation and Research Centre for Torture Victims

TOV Torture and Organised Violence

UN United Nations

WHO World Health Organisation

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Executive Summary

From 15 April to 15 June 2008, RCT funded a collaborative pilot trainingproject with Peoples Vigilance Committee on Human Rights (PVCHR) inVaranasi, India on Testimony as a Brief Therapy Intervention. The project

involved four weeks of training of PVCHR staff in May by the RCTPsychosocial Consultant, Inger Agger. The RCT Health Programme Manager,Peter Polatin, was responsible for the M6E component of the project.

The pilot project constituted phase one of a larger capacity building project:Brief Therapy Interventions Among Human Rights Organisations in CrisisAffected or Developing Countries. While the overall objective of the capacitybuilding project is to develop new knowledge about how to alleviate humansuffering and consequences of torture, the specific objectives of the pilotproject were as follows:

1. To develop a context specific manual for training in the use of theTestimony Method;

2. To build the capacity of the staff at PVCHR through a trainingworkshop;

3. To enhance the psychosocial wellbeing of a number of survivors ofTOV who were clients of PVCHR;

4. To summarise and analyse the results;5. Informally, to evaluate the possibilities for further collaboration between

RCT and PVCHR.

1. Choice of Testimony MethodTestimony therapy, which originated in Chile during the military dictatorshiphas been used in different variations for more than 25 years in a number ofcultural and political contexts: for refugees in Denmark, the Netherlands,Germany, Bosnia, Kosovo and USA; for survivors of civil war in Mozambique;for humanitarian aid workers in Iraq; and for Sudanese refugees in Uganda.

The testimony method was chosen for several reasons: (1) Indian humanrights organisations, which often use justice (not health) as their entry pointhad shown an interest in it; (2) it was in line with previous RCT work in India (astudy of psycho-legal counselling); (3) it was adaptable for a context with few

professional mental health staff resources; (4) it could be adapted for use as abrief therapy intervention; (5) the RCT psychosocial consultant had manyyears of experience with the method.

A Mindfulness meditation component was added to the testimony methodwith good results.

2. Project OutputsThe pilot project was very succesful and the following outputs were produced:

A manual for community workers and human rights defenders was

developed: Giving Voice: Using testimony as a Brief TherapyIntervention in Psychosocial Community Work for Survivors of Torture

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and Organised Violence(June 2008). The manual has beendistributed to a large number of human rights organisations inPVCHRs network and has also been posted on the RCT internationalwebsite. The Manual will be translated into Hindi and published inEnglish in the RCT Praxis Paper series.

12 community workers and human rights defenders from PVCHR were

trained in the Testimony Method, Mindfulness and M&E through a two-weeks workshop in which the first week was devoted to theory andpractical training, while the trainees in the second week madetestimonies and filled in M&E questionnaires of 23 survivors undersupervision.

23 survivors received two sessions of testimony therapy. A third

session in the form of a political action and delivery ceremony was heldin front of the District Government Headquarter of Varanasi wherefourteen testimonies were read out in public and delivered to thesurvivors who were also honoured with a cotton shawl (a symbol ofhonour in India) and a speech which praised their bravery andencouraged them to continue fighting for justice.

The results from this pilot project with PVCHR were promising and

invited for further collaboration between PVCHR and RCT. PVCHR hasproposed a one-year follow-up training project in collaboration withRCT, starting from August 2008. The project involves follow-upsupervision of PVCHR staff, training of other human rights

organisations, as well as a Consultative Meeting and a two-dayconference.

3. The M&E ComponentA database has been constructed at RCT International Department and thedata from the M&E questionnaires have been entered and analysed. TheHealth Programme Manager has the following conclusions andrecommendations on basis of the pilot phase of the project:

Continuation of the PVCHR Testimonial Project so as to increase the

N for the study, as well as to increase the number of beneficiaries and

expand the capacity of the organization to provide this brief therapy.

Expansion of the project by offering capacity building to other human

rights organizations. This should include an M&E system.

Modification of the questionnaire to elicit more consistency in the

responses and generate information that is more consistent with theactual realities of the beneficiaries.

Dedication of more resources to expanding M&E capacity in the

international work of the RCT. This will require expertise in theInternational Department at RCT.

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1. Introduction

RCTs mission includes the contribution of new knowledge about how toalleviate human suffering and consequences of torture1. The present partnerorganisations of RCT undertake various counselling interventions to assistvictims of torture, but the concept of counselling has different meanings fordifferent organisations, and there is a lack of knowledge about the most usefulpsychosocial interventions2. Therefore, a number of projects have beendeveloped to deepen the knowledge about best practices.

A fact-finding mission to India from 26 March 3 April 2007

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with visits toseveral Indian human rights organizations found that short-term counsellingseemed to be the rehabilitation method of choice for organizations visited.Most of the counselling methods observed were, in fact, variations of psycho-legal counselling, which has been the subject of an in-depth study by RCTand the Indian human rights organization, Jananeethi4, from November 2006 January 2007.

In psycho-legal counselling, justice constitutes the therapeutic entry pointand is an important element in the healing process. It would therefore seemnatural to introduce the testimony method in India, as this method is mostly

brief and can be used both in individual and community interventions. In thetestimony method justice is mostly considered an important healing element,although the method as explained below - has also been seen aspsychodynamic, existential, cognitive-behavioural, or narrative.

Two of the organizations visited during the RCT fact-finding mission to India inMarch-April 2007 (Swanchetan in New Delhi, and Peoples VigilanceCommittee for Human Rights (PVCHR) in Varanasi) expressed the wish tostrengthen their counselling capacity by receiving training through RCT in theuse of the Testimony Method as a Therapeutic Tool.

Following a third fact-finding mission to India, which occurred from March 23-30, 2008, it was decided by RCT to start a capacity building project in India

1 RCT (September 2004).RCT Policy: RCT Challenges and Targets in a Changing

World. Copenhagen: RCT.2 Olesen, J.S., Haagensen, J.O., Madsen, A-G. & Rasmussen, F. (2006). From

Counselling to Psycho-Social Development. Copenhagen: Rehabilitation and

Research Centre for Torture Victims.3 Haagensen, J.O., Wendt, E. % Agger, I. (2007). Fact-finding Mission to India.

Copenhagen: RCT, Report.4 Agger, I., Ansari, F., Suresh, S. & Pulikuthiyil, G. (2008). Justice as a Healing

Factor: Psycho-legal Counselling for Torture Victims in an Indian Context. Peace

and Conflict: Journal of Peace Psychology, Vol. 14 (3).

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and possibly expand it to other countries: Brief Therapy Interventions AmongHuman Rights organisations in Crisis Affected or Developing Countries.Phase One of this project was a pilot training project with PVCHR on thetestimonial method 15 April 15 June 2008.

Phase Two of the capacity building project is expected to start on 15 August2008 and include a larger training project with PVCHR, as well as training ofother NGOs in India, and in Sri Lanka and the Philippines (and possibly inother locations).

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2. Development of the Testimony Method

In 1983 two Chilean therapists described, for the first time, the use oftestimony5 as a therapeutic technique with torture victims and with relatives of

victims. The testimony was tape-recorded by the therapist and revised jointlyby therapist and patient into a written document, and the aim of the testimonywas to facilitate integration of the traumatic experience and restoration of self-esteem. However the authors note that, communication of traumatic eventsthrough testimony may also have been usefulbecause it channelled thepatients anger into a socially constructive action production of a documentthat could be used as an indictment against the offenders. The possibility ofputting their experiences to use resulted in the alleviation of guilt (p. 50).

The method was further described in 19906 as a ritual both of healing and ofcondemnation of injustice, and that the concept of testimony would seem tobe universal phenomenon: when political refugees give testimony to thetorture to which they have been subjected, the trauma story can be given ameaning, can be reframed: private pain is transferred into political dignity (p.115).

In a textbook from 1992 on counselling and therapy with victims of war, tortureand repression7, the testimony method was recommended as a briefpsychotherapy with motivated clients, or as a more flexible supplement toother approaches when the client has many other problems besides the TOV.

In 1994 the testimony method was used in a research project about thepsychotherapeutic treatment of women victims of sexual torture8, and in 1996it was explored in a Chilean context as a therapeutic tool developed in thepolitical framework of an active human rights movement9.

In 1998 the testimony method was studied in a South African context wherepublic testimony constituted the central mechanism in the South African Truthand Reconciliation Commission (TRC) process10. The authors locate thetestimony method within the broad framework of social constructionism and

5 Cienfuegos, A.J. & Monelli, C. (1983). The Testimony of Political Repression as a

Therapeutic Instrument.Amer. J. Orthopsychiat. 53 (1), 43-51.6 Agger, I. & Jensen, S.B. (1990). Testimony as Ritual and Evidence inPsychotherapy

for Political Refugees.Journal of Traumatic Stress, 3 (1), 115-130.7 Van der Veer, G. (1992). Counselling and Therapy with Refugees: Psychological

Problems of Victims of War, Torture and Repression. West Sussex, UK: John Wiley

& Sons Ltd.8 Agger, I. (1994). The Blue Room. Trauma and Testimony Among Refugee Women

a Psychosocial Exploration. London: Zed Books.9 Agger, I. & Jensen, S.B. (1996). Trauma and Healing Under State Terrorism.

London: Zed Books.10 De la Rey, C. & Owens, I. (1998). Perceptions of Psychosocial Healing and the

Truth and Reconciliation Commission in South Africa. Peace and Conflict: Journal

of Peace Psychology, 4 (3), 257-270.

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community in Mozambique with survivors of prolonged civil war15. The studyincluded an intervention group (n=66) and a control group (n=71) and traumasymptoms were measured during a baseline assessment, post-interventionand at an 11-month follow-up. A simple version of the testimony method wasapplied (only one session for most participants). It is concluded in the study

that, a remarkable drop in symptoms could not be linked directly to theintervention. Feasibility of the intervention was good, but controlling theintervention in a small rural community appeared to be a difficult task toaccomplish (p. 251). Concerning clinical implications of the study, the authorsfind that the introduction of the testimony method in a relatively small andisolated rural community was feasible and associated with the decrease ofreported psychiatric symptoms (p. 257).

In the same year, testimonial psychotherapy was used with traumatisedSudanese adolescent refugees in the United States who lacked experiencewith or interest in psychiatric care16. Testimonial psychotherapys unique

focus on transcribing personal, traumatic events for the altruistic purpose ofeducation and advocacy make it an acceptable interaction by which to bridgethe cultural gap that prevents young refugees from seeking psychiatric care(p. 31).

Also in 2004 a study was published comparing Narrative Exposure Therapy(NET) with supportive counselling and psycho-education for the treatment ofSudanese refugees living in a Uganda refugee settlement17. The resultsindicated that was a promising approach for the treatment of PTSD forrefugees living in unsafe conditions.

In 2005 the testimony method was also used for injured humanitarian aidworkers who had survived the bombing of the UN Headquarters in Iraq18. Themethod was found to be an effective tool: The testimony method provided asafe structure to recall the traumatic event, while assisting in thereconstruction of the traumatic memories and associated emotions, andoffered an acceptable motivation to do so (p. 57).

15 Igreja, V., Kleijn, Wim, C., Schreuder, B. J. N., van Dijk, J. & Verschuur, M.

(2004). Testimony Method to Amliorate Post-traumatic Stress Symptoms:Community-based Intervention Study with Mozambican Civil War Survivors.British

Journal of Psychiatry, 184, 251-257.16 Lustig, S.L., Weine, S.M., Saxe, G.N. & Beardslee, W.R. (2004). Testimonial

Psychotherapy for Adolescent Refugess: A Case Series. Transcultural Psychiatry, 41

(1): 31-45.17 Neuner, F., Schauer, M., Klaschik, C., Karunakara, U. & Elbert, T. (2004). A

Comparison of Narrative Exposure Therapt, Supportive Counseling, and

Psychoeducation for Treating Posttraumatic Stress Disorder in an Africal Refugee

Settlement.Journal of Consulting and Clinical Psychology, 71 (4), 579-587.18 Curling, P. (2005). Using Testimonies as a Method of Early Intervention for Injured

Survivors of the Bombing of the UN Headquarters in Iraq. Traumatology, 11 (1), 57-

63).

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Also in 2005, testimony therapy is reframed19 as an African-centred therapythat focuses on the personal stories of those who consult with the therapist,as well as the collective stories of the African experience in the United States(p. 5). In this narrative approach testimony therapy emphasises the personwithin community and is social constructionist in its outlook (p. 5).

The same year, Schauer, Neuner and Ebert (2005) publish a systematicanalysis and manual for how to use testimony in Narrative Exposure Therapy(NET)20 giving an overview of the theoretical background for understandingtraumatic stress, and the cognitively oriented therapeutic approach of NET.

In an Indian context it would seem useful and interesting to take the point ofdeparture in the research described above by Igreja, Kleijn, Wim et al., (2004)where they used the testimony method in a community-based interventionstudy with Mozambican Civil War Survivors. The authors of that study find thatthe testimony method is valuable in circumstances where there is a lack of

mental health care resources. They also emphasise that it is relatively easy tomaster, brief and does not require sophisticated materials. Another importantinspiration for the training and the Indian manual produced in our pilot projectwas the manual of NET by Schauer, Neuner and Ebert (2005).

2.1 Adding Mindfulness to the Testimony MethodThe consultant decided to add a mindfulness meditation component to thetestimony method, in order to further reduce stress, anxiety and depressivethoughts. Mindfulness-based stress reduction (MBSR)21 and mindfulness-based cognitive therapy (MBCT)22 have developed over the last twenty years,and have god empirical support for their effectiveness

Mindfulness is defined by Kabat-Zinn23 as: paying attention in a particularway: on purpose, in the present moment, and non-judgmentally (p. 4). MBSRand MBCT are inspired by Eastern traditions such as Buddhist meditation andyoga and would therefore seem especially applicable in an Indian context.

In relation to the testimony method (as well as NET), Mindfulness has provedeffective for narrative integration, the process whereby the life story isweaved together in a process of reflection and neural integration (p. 309-

19 Akinyela, M.K. (2005). Testimony of hope: African Centred Praxis for Therapeutic

Ends.Journal of Systemic Therapies, 24 (1), 5-18.20 Schauer, M., Neuner, F. & Elbert, Th. (2005).Narrative Exposure Therapy: A

Short-Term Intervention for Traumatic Stress Disorders after War, Terror, or

Torture. Gottingen: Hogrefe Verlag.21 Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body

and Mind to Face Stress, Pain, and Illness. New York: Dell Publishing.22 Segal, Z.V., Williams, J.M.G. & Teasdale (2002).Mindfulness-Based Cognitive

Therapy for Depression: A New Approach to Preventing Relapse. New York and

London: The Guilford Press.23 Kabat-Zinn, J. (1994). Whereever you go, there you are: Mindfulness Meditation in

Everyday Life. New York: Hyperion.

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310)24.

24 Siegel, D.J. (2007). The Mindful Brain: Refelction and Atunement in the Cultivation

of Well-Being. New York and London: W.W. Norton & Company.

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Week Two WORKSHOP ON TESTIMONIAL THERAPY

Day One Morning

Afternoon

Evening

(1) Mindfulness meditation(2) Preparation meeting: Division of participants in pairs

(one is interviewer and the other note-taker). Each pair willprovide two sessions of testimony therapy to a survivor inthe afternoon.

Two sessions of testimonies taken with first group ofsurvivors

Interviewers and note-takers correct and write thetestimonies

Day Two Morning

Afternoon

Evening

(1) Mi9ndfulness meditation(2) Supervision and process analysis meeting: Each pairreports experiences and problems from the day before:

what went well and what were the problems encountered

Two sessions of testimonies taken with second group ofsurvivors


Day Three Morning

Afternoon

Evening

(1) Mindfulness meditation(2) Supervision and process analysis meeting: Each pairreports experiences and problems from the day before:what went well and what were the problems encountered

Two sessions of testimonies taken with third group ofsurvivors


Day Four Morning

Afternoon

Evening


Two sessions of testimonies taken with fourth group ofsurvivors


Day Five Morning

Afternoon


Plans made for a delivery ceremony: where will it take placeand how will it be done (privately, in a public space, in acommunity meeting?)

Summing up, feed-back and closure

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3.2 Workshop ParticipantsThere were 12 participants in the workshop. Below follows a summery of their

personal data and professional backgrounds:

Name Ag

e

Mal

e

Femal

e

Education Englis

h

good

Englis

h

some

Englis

h

none

Work

Lenin 38 X BA in

Ayurveda,

Medicine

&

Surgery,

StateAyurvedic

Medical

College,

Haridwar

X Founder &

Director of

PVCHR

Human rights

of lower-

caste people:Dalit

ideologue,

access of

voiceless to

constitutional

rights

Shruti 33 X BA

Sociology

X Managing

Trustee of

PVCHR,

Community

human rights

work: Dalit

rights,

womens

rights, child

rights

Anupam

(sister of

Shruti)

31 X BA Hindi

and

Sanskrit

X Core Team

Member of

PVCHR,

Community

HR work:teacher,

health

supervisor

Upendra 24 X MA in

Social

Work

X Project

Coordinator,

Community

HR work

Shabana 28 X MA in

Social

Work

X Translator,

Community

HR WorkKarman 28 X MA X Associate.

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ya Sociology Documentati

on, advocacy,

reporting. HR

activist

Anjana 25 X MA in

Social

Work

X Intern,

Community

HR Work:

Health work

(TB), worker

education,

rural

development,

gender

Vijay 36 X Intermedia

te

X Core Team

Member of

PVCHR,Dalit Rights

activist,

educator,

Community

HR Work

Niraj 28 X MA in

Human

Rights

X Associate,

Journalist,

editor, works

with police

tortureAnand 31 X MA in

Ancient

Histroy

X Activist,

teacher,

Community

HR work

Daya 36 X High

school

X HR EU

monitor,

community

HR work:

children

Male 35 X 2 Activist,Community

HR work

The age of the participants ranged from 24 38 years. 6 of them were male,and 4 were female. 6 of the participants had an MA degree (in social work,sociology, history or human rights); 3 had a BA (in ayurvedic medicine,sociology or Hindi); and 3 had only an intermediate school education. 7understood English, and 3 spoke it well. 2 did not understand any English.

3.3 The Twenty-three Survivors who gave their TestimoniesThe 23 survivors who gave their testimonies were known to PVCHR. They

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had all previously given legal testimonies for use in court cases against theperpetrators. They were selected out of a group of approximately 80 clients ofPVCHR because they had shown evidence of psychological distress.

19/23 were male, and 2 belonged to the upper castes, while 13 belonged to

the backward castes and 8 to the scheduled castes. 21/23 were Hindus,while 1 was a Muslim and another was a Buddhist. There were 17 primaryvictims, and 6 secondary victims.

See Chapter 4 for further information about the mental health status of thesurvivors.

3.4 The Delivery Ceremony and political demonstrationThe training was concluded by a ceremony held in front of the DistrictGovernment Headquarter of Varanasi where 14 of the 23 testimonies wereread out in public and delivered to the survivors who were also honoured with

a cotton shawl (a symbol of honour in India) and a speech which praised theirbravery and encouraged them to continue fighting for justice.

The eyes of all the survivors and their family members were wet after hearingthe testimonies and they were feeling very happy and good inside. Mrs.Chanda Mushar started crying while she was honored with the testimony.The whole testimony process and ceremony was very successful. At the endof the ceremony all the survivors united and sat in a circle and interacted witheach other about their testimonies as if they had known each for a long time.

The ceremony also drew the attention of many people who were sitting in theDistrict Government Head Quarter square and everyone was curious to knowmore about the testimony method. The ceremony was transmitted by local TVnetworks and written about by the press, including the Times of India (fromthe press anouncement sent out by PVCHR to its network after theceremony).

3.5 Developing the ManualThe manual: Giving Voice: Using testimony as a Brief Therapy Interventionin Psychosocial Community Work for Survivors of Torture and OrganisedViolencewas developed in cooperation with the trainees during the

workshop. The manual has been distributed to a large number of humanrights organisations in PVCHRs network and has also been posted on theRCT international website.

It is the plan to translate the manual to Hindi, include illustrations orphotographs, and print it in English and Hindi. The English version will bepublished in RCTs Praxis Paper series.

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4. Review of the M&E Component by Peter Polatin, MD, HealthProgram Manager

The questions that constituted the M&E were derived from certainstandardized instruments (WHO 5 and Pain Analog), from application of ICFActivities &Participation categories, and from utilization of items fromstandardized questionnaire information already in use by PVCHR. Theexperiences of the RCT epidemiologic field study in Bangladesh, recentlyconducted by Dr. Sharlenna Wang, were also reviewed. The M&Equestionnaire was formulated in Copenhagen, but translated andcontexualized in Varanasi. However, it was not field tested prior to use in thePilot Study. Essentially, the Pilot Study WAS the field test for the finalizedM&E questionnaire, and it revealed certain problems with the questionnaire,which are summarized below.

4.1 Assessment of M&E Questionnaire: Problems to be remedied

Question # orDescriptor

Nature of theProblem

Suggestions forModification

5- Name Code Gives the participantsreal name- noanonymity

Introduce a coding schemeand remove the real names

11- Caste No responses Eliminate the question

12- Name of Caste Specific to Varanasi,but what aboutelsewhere?

Research whether applicableelsewhere in India, probablynot applicable anywhere else

14- Education missing response-3other response-1

Re-evaluate the question-should other terms beincluded?

14a- years spent inschool

No consistentresponse

Redo the entire educationquestionnaire

15-Occupation other response- 14 Same as above

15a-Occupationother

5 responses: rickshawpuller(1), tea stall(1),making plates(1),landless laborer(2)

Should these categores beincluded in Occupation, orshould some inclusive termbe used instead of other?

16-Activities no activities-16,other-4

Question needs to be re-written

16a- Activities other 4 responses: karmadancer(1), religious,political, andhumanitarian(1),trade union, political,religious(1), religious,humanitarian(1)

Re-write question 16 toinclude humanitarian,religious, political and tradeunion in various combinations

22-WHO 5 TotalScore

Range 0-20, Mean7.78, S.D. 4.8

Small sample, invalidstatistic, but a pathologic

score for the mean :It is recommended to

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administer the MajorDepression (ICD-10)Inventory if the raw score isbelow 13 or if the patient hasanswered 0 to 1 to any of the

5 items- Need to runcorrelation coefficientswith the variouspsychological symptomssolicited later on in thequestionnaire

All ICF questions (7-16)

invalid response as acategory

invalid means not validand doesnt mean disabled.Assigning it a value of 9serves to elevate thestandard deviation to indicate

lack of significance if invalidis the response..

12-998a: S/hespends time withhis/her friends

3 invalid responses Is the question understood? Itneeds to be rewritten and/orre-contextualized

13-998b: S/he goesto community andsocial events

5

14-998c: S/heattends religious

services

3

15-940a: S/heattends politicalmeetings

14

16-940b: S/heparticipates inpoliticalrallies, marches,demonstrations,strikes

14

20- S/he believes

that s/he has certainrights as a humanbeing that cannot betaken away byanyone.

15/23 said NO!!!! Is there a problem with the

question, the way it wasasked, or is it true that mostof these people do notbelieve they have any HumanRights?

Perpetrator oftorture

21/23-police Confirms a trend of which weare aware

# of torture episodes not specified- 90- 2

Was there a problem with thequestion or with the asking ofthe question?

Duration of thetorture (add onquestion because of

3 responses If there had been 9responses, it would havetaken care of the problem

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response to above) immediately above, butclearly it didnt. It suggeststhat the question needs to berewritten and re-contextualized

# of injured bodyparts

not specified-30- 2

Was it the question, or how itwas asked? Were thesepeople tortured, or not?

Other injured bodyparts (add on)

2 responses Expand the above questionto include these othercategories

Types of torture none-1 Was this person NOTtortured , or didnt understandthe question, or was asecondary victim

# of types ofphysical injuries

not specified-30- 1

Was the question not askedclearly?

Burns 0 Should the question continueto be asked?

Other injurydescriptors (add on)

2- swelling Add swelling to the InjuryDescriptor question

Evaluation aftertorture

All had at least 1Only one had xrays orblood tests

Since there were more thanone case of fracture, was theright information obtained?Or was it lack of quality care.

Treatment after

torture

No none, but 0 for

private hospital,surgery, orphysiotherapy

Consistent with above. These

torture victims did notnecessarily receive qualitymedical care

Other psychologicalsymptoms (add on)

2- fear Add fear to thePsychological Symptomquestion

Interventions beforetestimonial therapy

All said lawyer Since all of the participantswere at PVCHR, could weassume that they would allhave seen a lawyer or para-

legal? Do we need to ask thequestion?

Interventions beforetestimonial therapy

All said testimonial Does this mean that they hadalready had a testimonialbefore the testimonialtherapy? Or was there aproblem with asking thequestion?

4.2 Preliminary Statistical Data GeneratedIn spite of these problems, valuable information can be obtained from areview of the data. A list of derived means from questions of particularinterest is reviewed below, and also demonstrates items that yield problematic

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results.

Question Mean Variance S.D. comment

ICF: (0-3 active categories;9 is invalid> high mean and variance)

Function under stress d240 2.18 3.10 1.76

Family function d760 1.3 3.67 1.9

Human rights-political meetings d940 5.8 16.8 4.1 invalid

Human rights-demonstrations d940 5.5 18.9 4.3 invalid

Making a living now d870 1.69 1.4 1.18

Making a living before torture d870 1.0 1.18 1.08

Making a living immediately after torture

d870

2.26 1.019 1.009

Socialization- with friends d998 2.3 8.3 2.88 invalid

Socialization-community activities d998 2.4 13.2 3.6 invalid

Socialization- religious activities d998 2.0 9.09 3.01 invalid

Number of psychological symptoms (0-5)

3.3 2.4 1.55

Torture dose (empirical scale 0-3,derived from the questionnaire)

1.95 1.04 1.02

Torture injury amount (empirical scale 0-3, derived from the questionnaire)

1.76 1.39 1.179

Pain Analog (0-5 scale) 2.45 3.68 1.92WHO 5 Total Score (0-25) 7.78 23.1 4.8 invalid

4.3 Preliminary Conclusions Based on Initial Evaluation of the M&EStatistical significance is difficult to achieve with such a small sample size(n=23). It is possible, however, to derive some information from this initialreview of the preliminary data (post treatment data are yet to be derived).

The individuals who participated in this pilot study were mostly primaryvictims of torture. The perpetrators were almost always the police. Theparticipants ranged in age from 18 to 70 and were predominantly ofsecondary level education or less. The majority were Hindu, and all weremembers of a caste. They work at lower occupational levels, and do notconsider themselves political activists. Most of them are having currentdifficulties functioning under stress. Many are able to work and supportthemselves now with mild to moderate difficulty, but all were doing betterbefore they were tortured, and had much more difficulty with incomegenerating activities immediately after being tortured. Quite a few of themhave residual pain, and a low sense of wellbeing. Many of them have three ormore residual psychological symptoms subsequent to the torture event. Manydo not understand the issue of basic human rights, or could not appropriatelyanswer questions about issues related to politics and human rights. Most of

them received very low levels of health care after they had been tortured,although many of them had fairly extensive physical injuries. All had seen an

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attorney, reflective of the fact that they were involved with the PVCHR.

4.4 Conclusions and RecommendationsThis project has been a pilot in many different ways. Developing a meaningful

M&E database is a challenge that must be met so as to assess positive ornegative effect of an intervention, which will point to the need for modificationof the interventional component. With regard to this pilot project, and forRCTs continuation of Brief Therapies Projects as a Health Product to beoffered to partners in the future, certain things must be done:

1. Continuation of the PVCHR Testimonial Project so as to increase theN for the study, as well as to increase the number of beneficiaries andexpand the capacity of the organization to provide this brief therapy.

2. Expansion of the project by offering capacity building to other humanrights organizations. This should include an M&E system.

3. Modification of the questionnaire as outlined above to elicit moreconsistency in the responses and to therefore generate information thatis more consistent with the actual realities of the beneficiaries.

4. Dedication of more resources to expanding M&E capacity in theinternational work of the RCT. This will require expertise in theInternational Department at RCT that will:

Assist in the construction of M&E systems for specific projects

with partner organizations.

Collaborate with the partners in contextualizing questionnaires

so to ensure that they are understood and accurately answeredby the beneficiaries of interventions

Train partners to analyze the information derived in ways that

allow meaningful assessment of projects effectiveness and leadto new knowledge.

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organization, which will facilitate working with an English speaking psychosocial

consultant.

RCT is fortunate to have available a psychosocial consultant who is an acknowledged

international expert in the testimonial method. Dr. Inger Agger (IAG) has published

extensively about the application of this method in different post conflict societies,and recently completed a pilot project in another part of India. She is, therefore, the

ideal person to be hired as a consultant and trainer for this project.

Objectives

This mission is to be considered a pilot project which will serve as a spring board for

other missions to expand therapeutic capacity in Human Rights organizations working

with torture victims. It will accomplish the following objectives:

-To produce a contextually specific training manual for the application of the

testimonial method in Uttar Pradesh, India.-To train approximately ten members of PVCHR in the use of the testimonial

method, and to provide supervision to their application of this therapy.

-To select and start treatment of approximately 20-30 individuals who have

undergone torture and are suffering from significant emotional sequellae.

Additional criteria for participation of these individuals will include adult

status and mental competence.

-To introduce a Monitoring and Evaluation methodology to PVCHR which

will enable the organization to monitor their therapeutic interventions. This

will include some brief standardized instruments as well as ICF categories to

provide functional measures. It will also serve as a data base for follow up ofthe project.

Outputs

-A cadre of trained personnel who will have demonstrated competency in the

testimonial method and will be able to provide this service to clients of PVCHR who

are in need of psychotherapy.

-The treatment of a group of approximately 30 victims of torture with emotional

distress symptoms, who will demonstrate improvement in function

-A monitoring and evaluation questionnaire which may be utilized by PVCHR to

document its impact in the provision of psychotherapeutic treatment services to needy

clients.

-A database for patients who have completed the testimonial therapy which will

include socio-demographic information and details of the torture experience, as well

as before and after indices of general well being, pain level, and functional

activities and participations.

-The planning of a broader psychotherapy project for PVCHR and the application of a

similar project to other organizations servicing torture victims in other parts of India.

Time Frame and Methodology

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The psychosocial consultant will be hired on a two month contract (44 working days,

effective on April 15, 2008. From 15 30 April will be in Copenhagen, where the

consultant will develop a draft training manual and the HPM will develop a

questionnaire and a data collection methodology which will serve as the basis for the

projected monitoring and evaluation system. The HPM, with assistance from the

Research Department, will construct a data base format which can be used for dataentry, either in the field or in Copenhagen.

The month of May (1 30 May) will be in Varanasi, where the consultant will work

with the personnel of PVCHR to 1.) refine and translate the training manual, 2.) refine

and translate the M&E questionnaire, 3.) train and supervise the identified personnel

of PVCHR in the application of the testimonial method, and 4.) train and supervise

the personnel in the use of the M&E questionnaire.

Finally, the consultant will return to Copenhagen from 1 15 June during which she

will compose a full report and synthesis of the project (maximum 20 pages +attachments), including assessments of the success of the training, the applicability of

the M&E questionnaire, and trends observed after start of the therapy. Lessons

learned will be particularly applicable recommendations for future projects of this

nature, as well as continued cooperation with PVCHR. The HPM will process and

analyze the pre-testing data, with the assistance of the Research Department.

Division of Responsibilities

The psychosocial consultant will be responsible for the Testimonial Project. These

functions include the development of the training manual, the translation andcontextual adjustment of the training manual in India, the training of approximately

ten staff members of PVCHR in the administration of the testimonial method, and the

initial supervision of these personnel in their use of the testimonial method. She will

also introduce the M & E questionnaire, have it translated, train and supervise the

trainees in its application and use. This will include their collection and recording of

information for the instrument in the field and at the PVCHR office.

Before departure to India of the consultant, the HPM will construct the M & E

Questionnaire, produce a data collection methodology, and set up an electronic data

spread sheet for data collection and storage. The consultant will bring electronic

copies of these three documents to India.

After the return of the consultant, the HPM will oversee the analysis of the data from

the pre-testing, which will be sent to him from India by the consultant (with the

assistance of the Research Department). This analysis will be available to the

consultant for her report writing in June.

It remains to be determined after the visit of the consultant to PVCHR how the post-

testing data will be transferred to RCT, and how the further supervision and M&E

process with PVCHR will be carried out.

The HPM will also maintain close contact with the Psychosocial Consultant while she

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is in the field, and provide logistical support.

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Annex II. Memorandum of Understanding

MEMORANDUM OF UNDERSTANDING (MOU)

Between

Rehabilitation and Research Centre for Victims of Torture

And

Peoples Vigilance Committee on Human Rights

This is an agreement between Rehabilitation and Research Centre for Victims ofTorture, hereinafter called RCT and Peoples Vigilance Committee on Human

Rights, hereinafter called PVCHR

I. PURPOSE & SCOPE

The purpose of this MOU is to clearly identify the roles and responsibilities of each

party as they relate to the pilot project: TESTIMONIAL THERAPY PILOT

CAPACITY BUILDING PROJECT

In particular, this MOU is intended to ensure a concrete working relationship between

RCT and PVCHR. The basis for the working relationship is found in the RCT Fact

Finding Report II + III from visits in year 2007 and 2008 to PVCHR in Varanasi,

Uttar Pradesh.

II. BACKGROUND

PVCHR was started in 1996 and is a human rights organisation working to ensure

basic rights to vulnerable groups and a human rights culture based on democratic

values. PVCHR is engaged in organization building from the village level to the

national level by working in districts of U.P., M.P. and Bihar on the issues of human

rights, torture victims. PVCHR has an advisory committee including Justice V.S.

Malimath, Former Chief Justice of Kerala, Karnataka & Ex-Member-NHRC.

RCT was started in 1982 and is a human rights organisation with particular focus on

rehabilitation and prevention of torture and organised violence. RCT is working in

Denmark and together with a number of partner organisations around the world. RCT

is governed by a board comprising members of key research institutions and

universities.

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In year 2007 and 2008 RCT conducted two fact finding missions to India. The two

missions reconfirmed that in Uttar Pradesh, and elsewhere in India, torture is used as

standard procedure in police stations for extracting information, forcing confessions,

and obtaining bribes from the persons who are entrapped.

RCT efforts will concentrate on building capacity and organising training in thetestimonial method for Indian psychosocial organizations, beginning with a pilot

project with PVCHR. The Testimonial Method represents a form of brief

psychological therapy which elicits a detailed self report of events of torture.

PVCHR works on a wide range of Human Rights Issues, and interact directly with

communities of traumatized survivors of torture and violence. However, while

community empowerment and individual advocacy are major activities of this

organization, direct health care, psychosocial services, and rehabilitation are not

provided at the present time. PVCHR has expressed an interest in developing a

capacity in the testimonial method, and has requested that RCT provide training andsupervision to achieve this capacity.

By their joint signatures on the MOU the two parties recalls that the current/historical

ties between RCT and PVCHR are a shared vision on a world free of torture and

organised violence. The cooperation is guided by mutual trust and sharing of

resources as to ensure successful implementation of the Testimonial project.

III.[PVCHR]RESPONSIBILITIES UNDER THIS MOU

PVCHR shall undertake the following activities:

o Support the Testimonial Pilot project in accordance with the objectives

outlined in the LFA Matrix (see Annex I)

o Provide logistic support for the pilot project (office and training space, office

supplies and other necessary practical support such as access to internet,

photocopying, printing etc.)

o Recruit a qualified interpreter for ensuring effective translation during the

training course

o Identify the participants for the training and compose a mixed group of male

and female participants

o Ensure that the participants are released from other PVCHR duties and will be

able attend the training course during its full period

o Support the RCT consultant in the timely implementation of the training

schedule in accordance with the proposed day to day training plan (see Annex

II)

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o Organise food, snacks and drinks for the participants during the duration of the

training

o Organise transportation of participants for the field work

o Identify and prepare the torture survivors who will participate in the

testimonial therapy during the time of field work

o Maintain testimonial records obtained from the torture survivors and provide

these records in copy to RCT

o Evaluate the training course during and after its completion and give valuable

learnings and recommendations back to RCTIV.[RCT]RESPONSIBILITIES UNDER THIS MOURCT shall undertake the following activities:

o Recruit an expert consultant in the Testimonial Therapy, who will have the

professional responsibility for the project, and cover all costs of the consultant

(fee, per diems, insurance, travel, and other costs)

o Ensure that the expert consultant will deliver her services timely and in

accordance with the LFA Project Matrix and the training schedule as covered

under this MOU agreement

o Provide financial support to PVCHR as to cover all basic administrative and

project related costs in connection with the implementation of the pilot project

(see Annex III)

o Ensure that RCT will share learnings and experiences with PVCHR related

to the evaluation of the pilot Testimonial project

o Analyse and share all relevant materials and testimonial records from the pilot

field work with PVCHR

o Provide professional backup and advice by the RCT Health Manager and the

RCT Project Manager for Asia should the need occur during the

implementation of the project

V. IT IS MUTUALLY UNDERSTOOD AND AGREED BY AND BETWEEN THE

PARTIES THAT:

1. Modification

The MOU or the activities covered by the MOU may be modified by mutualagreement between the two parties

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2. Termination

The MOU may be terminated by giving notice by one of the parties signing the MOU

VI. FUNDING

This MOU does include the reimbursement of funds between the two parties. Theindividual payment for services (see Annex III) will be done by the RCT consultant

and follow the fulfilment of the assigned task as these have been verified by the RCT

consultant.

The final accounts for the pilot project following the layout in the detailed budget

with all original vouchers attached will be verified by RCT consultant and all original

vouchers related to this pilot project shall be handed over to RCT.

VII. EFFECTIVE DATE AND SIGNATURE

This MOU shall be effective upon the signature of RCT and PVCHR authorized

Officials. It shall be in force from May 1, 2008 to May 30, 2008.

RCT and PVCHR indicate agreement with this MOU by their signatures.

Signatures and dates

Dr. Jan Ole Haagensen Dr. Lenin Raghuvanshi

_____________________________ _____________________________Date Date

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Annex III. M&E METHODOLOGY, by Peter Polatin, MD. HealthProgram Manager

What is the purpose of an M&E?

When a therapy is administered to an individual, it is important to have information

about him or her beforehand, and to be able to document and analyze change after the

intervention. It is only by comparing certain characteristics of the individual before

and after the therapeutic process that the benefit of the intervention can be

determined. This, in turn, helps clinicians to decide whether or not to continue

administering the therapy, and what changes need to be made to improve its effect.

These records are very important, and should be stored in a secure place.

Confidentiality should be ensured. The forms have been constructed in such a way

that the information can be transferred to a digital data base for subsequent analysis

and study as part of later projects.

The PVCHR M&E Questionnaire consists of four parts:

I. History and Demographic Information

II. Pre and post therapy testing

III. Post therapy assessment

IV. Information about therapy and coping assessment

Part I: History and Demographic Information

This section elicits relevant information about age, sex, address, caste, religion,

education, work experience, and political activities. It largely follows the format ofthe larger PVCHR questionnaire. Assuming that the PVCHR questionnaire has

already been completed, the information can be transferred to this shorter form.

Otherwise, it can easily be completed in direct interview within a few minutes.It

deliberately excludes any information about experiences with torture, which are felt

to be better elicited after the actual testimonial intervention.

Part II: Testing before and after the testimonial therapy intervention

This section is designed as a simple checklist which can be completed by either the

subject or an interviewer. It is anticipated that in almost all cases the questionnaire

will be administered by a health worker. The questions have between 2 and 6qualitatively arranged answers. It is to be administered to the treatment candidate

immediately before and one month after the testimonial therapy experience, so as to

document changes in well being, pain, and functional activities and participations.

There are 21 questions.

Thefirst 5 questions constitute the WHO5, which is a standardized test

measuring quality of life.The raw score for this test is calculated by

totalling the figures of the five answers. The raw score ranges from0 to 25, in which 0 represents the worst possible and 25 representsthe best possible quality of life. A raw score below 13 indicates poor

wellbeing and is an indication for depression. To obtain apercentage score ranging from 0 to 100, the raw score is multiplied

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by 4. A percentage score of 0 represents the worst possible qualityof life, whereas a score of 100 represents the best possible qualityof life. In order to monitor possible changes in wellbeing, thepercentage score is used.A 10% difference indicates a significantchange.

Question 6 is a pain analogue. The interviewee expresses hislevel of pain as a function of time, ranging from pain all the time (5)to no pain at all (0). Pain is frequently seen in individuals who havebeen tortured, and therefore it is important to document itspresence. In many cases, pain decreases when well being increases,so that an improvement in the WHO5 may be associated with adecrease in pain level, and in association with a beneficial effectfrom the therapeutic intervention.

Questions 7-16 have been derived to measure specific activitiesand participations (D

categories) as classified under the ICF. These categories havebeen selected as particularly relevant, as the result of an extensiveprior M&E project undertaken by RCT with its Partners in the Southwhich included three international workshops and the collaborationof an RCT psychosocial consultant with most of the Partners during2007(see Strengthening of Psychosocial Intervention Practices Among RCTPartners:ICF Follow-up Missions to Seven Partner Organisations,Synthesis Report,

Draft Final Report, December 2007, Inger Agger, PhD, Psychosocial Consultant).

The qualifiers used are the same as the modified qualifiers decidedupon by the RCT project.; i.e., 4 degrees from 3 (complete difficulty)to 0 (no difficulty). For the purpose of later review of information,

however, the not specified and not applicable categoriessuggested by the original RCT project have been lumped into asingle new invalid category, with a high numeric score whichwould serve to identify invalid responses as outliers. The actualphrasing of the questions was done by the RCT Health ProgramManager, Dr. Polatin, in consultation with other ICF experts andresearchers.

Question 7 asks about D240 (handling stress and otherpsychological demands) and elicits separate opinions from theinterviewee and the interviewer. This is very important, because theinterviewer, who is a health worker, is being asked to record his orher own judgement about the interviewees ability to function underpsychological demands. While he will ask the question of theinterviewee for the first part of the question, he will answer thesecond part silently from his own opinion.

Question 8 asks about D 760 (family relationships).Questions 9-11 ask about D870 (economic self sufficiency) at

three different times: the present time, before the torture event,and immediately after the torture event. It is of interest todocument the impact of torture on economic self sufficiency, as wellas to document a change in economic self sufficiency after

treatment (question 9). Only the answer to question 9 shouldchange after treatment. It is expected that the answers to questions

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exactly as possible, and 3.) health and functional information aboutthe treatment group is accurately collected and stored for laterreevaluation. A careful and comprehensive M&E is as important asthe therapeutic process, because it confirms health benefits andtherefore justifies application for further funding and extension of

treatment services.

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Annex IV. Pilot Questionnaire, by Peter Polatin, MD, HealthProgram Manager

(Text in red represents changes made following suggestions by PVCHR)

PVCHR

TESTIMONY

THERAPY

PROJECT

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I. HISTORY AND DEMOGRAPHIC QUESTIONNAIRE

(to be administered before testimony therapy)

DATE_________________________

NAME OF COMMUNITY WORKER TAKING THE

TESTIMONY__________________________

NAME OF SURVIVORS VILLAGE________________________________

ADDRESS ____________________________________________________________

NAME (code

designation)_________________________________________________________________

SEX Male _____ Female ________

PRIMARY VICTIM_____ SECONDARY VICTIM (Relation to primary victim): Son____

Daughter____ Father_____ Mother _____ Husband ____ Wife ____ Other ______

AGE_____________________

CASTE No caste:_____ Does not believe in caste______ No answer______

NAME OF CASTE (if applicable)____________________________

RELIGION Hindu____ Buddhist_____ Muslim______ Christian______ Atheist_____

Other_____

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EDUCATION None_____ Primary_____ Secondary_____ BA_____ MA_____ Religious school

only_____Other_________________________________________________

OCCUPATION Not working___ Household work____ Agriculture____ Animal husbandry ____

fishing_____ Business____ Government or political position ____ Public service, journalism,

teacher____

Lawyer, doctor____ Other_______________

ACTIVITIES Trade union____ Political____ Religious____ Humanitarian/solidarity____ Press____

No activities _____ Other____

II: PRE AND POST TESTIMONY TESTING

(to be administered before testimony therapy and one month after therapy)

Categoryof

instrumentOver the last two weeks All the

time

Most of

the time

More than

half of the

time

Less than

half of

the time

Someof

the

time

At no

time

W 1 S/he has felt cheerfuland in good spirits

5

4 3

2

1

0

H 2 S/he has felt calm

and relaxed

5

4

3 2

1

0

O 3 S/he has felt active

and vigorous

5

4

3

2

1

0

/ 4 S/he woke up feeling

fresh and rested

5

4

3

2

1

0

5 5 His/her daily life has

Been filled with thingsthat interest him/her

5

4

3

2

1

0

Pain

Analogue

6 S/he has had persistent

Pain

5

4

3

2

1

0

Complete

difficulty

Moderate

to severe

difficulty

Mild

difficulty

No

difficulty

Invalid

ICF A&P

D-240

7 S/he can get everything

done that is important

for him/her to do, even when

s/he is nervous, depressed,

tired, angry, or in pain

3

2

1

0

9

D-760 8 S/he gets along with the people

In his/her family and spend

time with them

3

2

1

0

9

D-870 9

S/he is able to earn enough money to support

him/herself and the people who dependon him/her

3

2

1

0

9

10

Before s/he was tortured, s/he was able to earnenough money to support him/herself and the

people who depend on him/her

3

2

1

0

9

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1

1

Immediately after s/he was tortured, s/he wasable to earn enough money to support

him/herself and the people who depend on

him/her

3

2

1

0

9

D-998 1

2

S/he spends time withhis/her friends

3

2

1

0

9

13

S/he goes to community andsocial events

3

2

1

0

9

1

4

S/he attends religious services

3

2

1

0

9

D-940 1

5

S/he attends political meetings

3

2

1

0

9

1

6

S/he participates in political

rallies, marches,demonstrations, strikes

3

2

1

0

9

1

7

S/he is a member of a

political party

1

YES

0

NO

1

8

S/he actively works for a political party

1

YES

0

NO

1

9

Is s/he member of the human rights movement YES NO

2

0

S/he believes that s/he has certain rights as a

human being that cannot be taken away by

anyone.

1

YES

2

NO

Recent

Events

2

1

A good thing has happened to him/her

that has made him/her feel happy

1

YES

0

NO

22

A bad thing has happened to him/herthat has made him/herfeel much worse _ 1

YES

0

NO

III. POST THERAPY ASSESSMENT

(to be completed after the testimonial, and derived from that

document. If the survivor interviewed is a secondary victim all items should

refer to his or her physical and mental state)

DATE OF MOST STRESSFUL EVENT___________________________

IDENTITY OF PERPETRATOR(S) Police____ Intelligence service____ Armed forces____ Paramilitary____

Prison official____Other____________________________

NUMBER OF EPISODES OF TORTURE__________ NOT TORTURED________

TYPES OF HUMAN RIGHTS VIOLATIONS Physical torture______ Psychological torture ______ Sexual torture _____

Custodial death of primary Victim_______ Extra-judicial killing of primary victim ________ Other

types________________________________

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INJURED PARTS OF BODY Head___ Face___ Eyes___ Neck___ Arm___ Both arms___ Chest___ Breasts___

Abdomen___Genitalia___ Back___ Leg___ Both legs___ Foot___ Both feet___ Not injured______

NATURE OF INJURY Bruise____ Open wound____ Burn____ Deformity___ Fracture____ Amputation___

Loss of strength____ Loss of sensation____ Loss of function____ Pain____ Not injured_______

PSYCHOLOGICAL SYMPTOMS Nightmares___ Memories___ Fear of going out___ Self isolation____ Panic attacks____

Anxiety____ Depression____ Suicidal thoughts____Cant sleep____ No symptoms______

EVALUATION AFTER HUMAN RIGHTS VIOLATION None___ Doctor visit___ Xrays____ Blood tests____ lawyer or

human rights organization______

TREATMENTBEFORE TESTIMONY THERAPY None___ Private hospital___ Public hospital___ Surgery___

Medication____

Physiotherapy____ Counseling____ Legal aid______ Testimony before tribunal______

IV. POST-THERAPY TESTING

(to be completed one month after testimonial therapy has been done)

NUMBER OF TESTIMONY SESSIONS _____

WILL THE TESTIMONY BE PUBLISHED OR USED FOR HUMAN RIGHTS WORK? Yes___No___

OTHER INTERVENTIONS (BY PVCHR OR OTHER ACTORS) : Medical____ Social____ Legal_____Reading of

testimony at Folk School Meeting______

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_________________________

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Complete

difficulty

Moderate to

severe

difficulty

Mild

difficulty

No

difficulty

Invalid

Community workers assessment of the

capacity of the survivor to manage stress and

other psychological demands

3

2

1

0

9

Annex V. Proposal for Further Collaboration PVCHR/RCT

DRAFT PROPOSAL

TRAINING IN TESTIMONY THERAPY FOR

COMMUNITY WORKERS AND HUMAN RIGHTS DEFENDERS

A TRAINING-OF TRAINERS PROJECT

PEOPLES VIGILANCE COMMITTEE ON HUMAN RIGHTS (PVCHR)

&REHABILITATION AND RESEARCH CENTRE FOR TORTURE VICTIMS

(RCT)

1. Background

From April to June 2008, RCT funded a collaborative pilot training project with

PVCHR on Testimony as a Brief Therapy Intervention. The project involved four

weeks of training of PVCHR staff by an RCT psychosocial consultant, as well as the

production of a manual for community workers and human rights defenders: Giving

Voice: Using testimony as a Brief Therapy Intervention in Psychosocial Community

Work for Survivors of Torture and Organised Violence (June 2008).

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The success of this pilot training project invited for further continuation of the

collaboration between PVCHR and RCT.

Before her departure from Varanasi, the RCT consultant discussed various

possibilities for future collaboration with Dr. Lenin, Convener of PVCHR, and they

agreed on proposing a follow-up to the pilot project, as well as a Training-of-Trainersproject for community workers and human rights defenders in other human rights

organisations, which PVCHR are networking with.

2. Proposed timeframe

12 Months starting 1 August 2008.

3. Follow-up activities of pilot project

Third session: Delivery ceremonies in the communities for the seven survivors

who did not participate in the Varanasi ceremony (by beginning of July):

Fourth session with 23 survivors: Concluding the M&E of the 23 survivors

who have been treated (by end of July);

Translation of Manual to Hindi (August);

Illustration of Manual by drawings or photographs (August);

Supervision (3 days) by psychosocial consultant in Varanasi to follow up of

pilot training (September);

Consultation meeting with national and state human rights institutions, human

rights groups, media, mental health professionals - including Nimhans

(September-October);

Possible revision of Manual on basis of comments received at the Consultation

(October);

Printing of Manual in Hindi and English (by end of October).

4. Training-of-Trainers project

4.1 Activities

First training (two weeks): November 2008 in Varanasi for 10-15 human rights

defenders from different organisations in UP, Bihar and Madhya Pradesh;

Second training (two weeks): February 2009 in Ranchi (capital of Jharkhand) for 10-

15 human rights defenders from Manipur, Jharkand and Chhatisgarh;

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Two-day conference in New Delhi (April 2009):

1. On the first day: Discussion of psychosocial work, psychological rehabilitation

survivors of TOV and the effect of the testimony method with professionals,

selected survivors, participants in the training courses, human rights

institutions, human rights groups, and the media.2. On the second day: A core team is formed for the future strategy for using the

testimony method in the political campaign against torture.

Evaluation of project by external consultant;

Writing of articles analysing the results.

4.1 Staff resources needed

Four PVCHR staffact and are employed as supervisors in testimony therapy in thefield and coordinate all activities (From August):

Two trainers for the ToT training: Dr. Lenin and Dr. Agger

Good translator.

26 June 2008/Inger Agger, Psychosocial Consultant

Annex VI. PVCHR Press Announcement about Workshop,Ceremony and Demonstration

TESTIMONY: A SOCIAL MOVEMENTA lot of political and lawful struggle against police torture and other

organized types of violence are happening. However, in the human rightsorganizations of India resources have been scant for providing short-term

psychosocial assistance to survivors suffering from psychological

problems. This type of assistance has mostly been provided by trained

psychologists or psychiatrists in medical centers. It is, therefore,

necessary for the organizations working on the grass-roots level to

develop their capacity for this type of brief therapy assistance, which can

be carried out by non-professional staff.

Testimony therapy has been used for survivors of human rights violations

in different parts of the world during the last 25 years starting in Chile,

Latin America. By giving testimony about the torture - telling the self

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suffering story - to an empathic listener who records the story, the

survivor can heal his or her trauma and also use the testimony document

in the struggle for justice. In this way the private pain becomes political

and the survivor is empowered.

Steps in testimony THERAPY:1. During two sessions, the survivor tells the story of his or her

suffering to a community worker or human rights defender who

helps the survivor remember the suffering and feel the emotions at

that time and in the present. One community worker acts as the

interviewer while the other acts as a note-taker. Together with the

survivor they create a coherent story about the human rights

violations suffered by the survivor.

2. In the beginning of the second session, the story is read out in front

of the survivor as an autobiography and corrections are made if the

survivor wants to add or change something in the story.

3. At the end of each session, the interviewers and the survivor sit for

ten minutes in a mindfulness meditation experience with focus

on the awareness of the breath and the thoughts going through the

mind.

4. For the third and last session, the testimony is prepared in colorful

and attractive paper with the signature of the survivor and the

interviewer. An honor ceremony is organized where the testimony

is handed over to the survivor. If the survivor agrees this ceremony

can be public and the testimonies of several survivors might be

handed over on the same occasion. A copy of the testimony will be

used for further advocacy with the acceptance of the survivor.

5. The testimonies of survivors can also be used in folk schoolmeetings, community meetings, programs related to human rights,

as part of a peoples movement and in workshops for the police to

prevent torture.

In this context a workshop on testimonial therapy was organized with the

joint collaboration of the Rehabilitation and Research Centre for

Torture Victims (RCT) Denmark and Peoples Vigilance Committee

on Human Rights (PVCHR) from 12th May, 2008 to 23rd May, 2008.

In the workshop 12 human rights defenders from PVCHR were trained inTestimony Therapy by Dr. Inger Agger, Psychologist from RCT,

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Denmarkand the participants thereafter took the testimonies of 23

survivors under the supervision of Dr. Agger. During the workshop a

special manual for the use of Testimony Therapy in India was created.

The title of this manual is Giving Voice. The manual will be translated

into Hindi.The workshop was followed by a ceremony of honor, in which 14 of the

survivors who had given their testimonies received their testimony

documents.

The ceremony took place on 27th May, 2008 at 11 am to 14 pm where the

14 survivors gathered in front of the District Government Head Quarters

of Varanasi. The names of the honored survivors were Mr. Kaju, Ms.

Anita (not real name), Mr. Ajay Singh, Ramu (not real name), Mr.

Jaswant, and Mrs. Munni Devi, Mr. Ram Prasad Bharti, Mr. Devnath,

Mr. Ram Lal, Mr. Pahalu Mushar, Mrs. Chanda Mushar, Mr. Hub RajMushars, Mr. Banshi Rajbhar, Mr. Satendra Yadav.

Group photo with the survivor and Dr. Inger Agger RCT, Denmark

The ceremony started with a brief introduction where the Testimony

Therapy was explained. Thereafter, the testimonies of 12 of the survivors

were read out to the public by the interviewers who took the testimonies,

and the survivors were honored by giving them a flower garland, a white

shawl and the testimony document.

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The testimony is read out by the Human Rights Defender

The eyes of all the survivors and their family members were wet after

hearing the testimonies and they were feeling very happy and good

inside. Mrs. Chanda Mushar started crying while she was honored with

the testimony.

The whole testimony process and ceremony was very successful. At the

end of the ceremony all the survivors united and sat in a circle and

interacted with each other about their testimonies as if they had known

each for a long time. The ceremony also drew the attention of many

people who were sitting in the District Government Head Quarter square

and everyone was curious to know more about the testimony method.

The ceremony was also transmitted by local TV networks and written

about by the press, including the Times of India.

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first pilot project of pvchr-rct for testimonial therapy

Documents