Interview Considerations

General Interview Considerations

Before Approaching the Patient

In order to aid in the establishment of a fiduciary relationship with your client/patient, it is helpful to become aware of the risk factors related to a history of torture (see figure below). Learning about the political situation of the country where your client/patient is from, as well as the ethnic conflicts, geography, and main cultural values characteristic of his/her country of origin prior to the first meeting will help you act sensitively and begin meeting his/her possible special needs from the very beginning. In addition, refugees and survivors of torture interpret this knowledge as a genuine interest in them, enhancing the development of a trust-based relationship (1).

How to Approach the Patient

To avoid re-traumatization, any health or legal professional conducting an interview with a refugee or a survivor of torture should follow some basic guidelines (1). You should introduce yourself, explain the purpose of the interview, and delineate how the interview will progress. When interviewing a person under arrest or detained, you should explain how you became involved in the case (1-2). In addition, you should avoid having refugees and survivors of torture wait for an interview because it resembles the waiting period before an interrogation session (2).

Interviewers should make refugees and survivors of torture feel that they are in control during the interview. Therefore, allow refugees and survivors of torture to take breaks, decline answering questions, and stop the interview at any point. In addition, you should avoid rushing the patients or asking questions too fast because they recreate an interrogation (2-3).

Initially, questions should be open-ended allowing a narration of the trauma without many interruptions. This technique of open-ended questions builds empathy and trust between the victim and the interviewer.  However, you should carefully redirect the interview with another open-ended question if the client/patient wanders off the subject of interest.

Short answer questions, particularly those necessary to obtain details of the trauma (how did it happen, when did it happen, where did it happen, what part of the body was affected and what object was used), should be left to the second part of the interview or to subsequent interviews if possible. You should remember that short answer questions may resemble an interrogation. Therefore, questioning should be done gently and tactfully to avoid re-traumatization (2).

Finally, during the physical exam, health professionals should explain to the patient every step of the examination beforehand to avoid re-traumatization. For instance, if you dim the lights of the exam room to visualize the retina with an ophthalmoscope without first warning the patient, he may re-live confinement in a dark cell. Similarly, if you pull the ear of the patient to visualize the middle ear, the patient may re-experience the moment when her captors forcefully pulled her ears.

Health professionals who evaluate a survivor of torture only for an asylum evaluation should make a reasonable effort to find another health professional who could provide long-term medical or psychological care (3).

References:
1. Podliska T. Interviewing Asylum Seekrs. In: Political Asylum Immigration Representation Project. Representing Asylum Seekers. Boston , 1999. p II-1 – I-8.

2. Weinstein HM, Dansky L, and Iacopino V. Torture and War Trauma Survivors in Primary Care Practice. West J Med 1996; 165: 112 – 118.

3. Randall GR and Lutz EL. Approach to the Patient. In: Serving Survivors of Torture. American Association for the Advancement of Science. 1991.

The Setting

Refugees and survivors of torture should be interviewed and examined in a place that offers privacy. When asylum seekers are detained and the interview needs to take place in a detention center, interviewers should delay the interview if the person will be released soon and there are no time constraints.  Otherwise, if absolute privacy cannot be assured, you should keep all sensitive questions for a follow-up interview.  If no other interview can be arranged, you must document all the limitations present during the evaluation (1-3).

Weinstein and co-workers also add that the place should be comfortable, have adequate lighting and no hidden objects, and be as un-cell-like as possible (2).  When interviewing detainees, health providers should request from prison officials an exam room where a physical exam can be conducted (1-3).

References:
1. Podliska T. Interviewing Asylum Seekrs. In: Political Asylum Immigration Representation Project. Representing Asylum Seekers. Boston , 1999. p II-1 – I-8.

2. Weinstein HM, Dansky L, and Iacopino V. Torture and War Trauma Survivors in Primary Care Practice. West J Med 1996; 165: 112 – 118.

3. Iacopino V, Ozkalipci O, Schlar C. General Interview Considerations. In: Manual on the Effective Investigation and Documentation of Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment (The Istanbul Protocol). Available at: http://www.phrusa.org/research/torture/index.html [Accessed 05/11/01 ].