Although there is no consensus on how to define and operationalize torture (Green, Rasmussen, & Rosenfeld, 2010), there is general agreement that torture is one of the most devastating human experiences. Indeed, a growing body of evidence on the implications of torture and atrocities experienced by prisoners of war or survivors of political violence presents a consistent picture of multifaceted injuries and long-lasting emotional and functional difficulties, including posttraumatic stress disorder (PTSD) (Neria et al., 2000; Steel et al., 2009), anxiety (Keller et al., 2006), depression (Steel et al., 2009), endured shame and guilt (Wenzel, Griengl, Stompe, Mirzaei, & Kieffer, 2000), disability (Thapa, Van Ommeren, Sharma, & de Jong, 2003) and impaired quality of life (Eisenman, Gelberg, Liu, & Shapiro, 2003), and increased interpersonal aggression (O’Donnell, Cook, Thompson, & Neria, 2006). Exposure to prolonged and repeated intentionally inflicted aggression not only evokes substantial distress but also affects victims’ personality (Herman, 1992), resulting in dissociation and an impaired sense of identity (Herman, 1992) as well as profound changes in attachment and relationship (Solomon, Dekel, & Mikulincer, 2008) and victims’ core belief system (Magwaza, 1999). In light of the complexity and severity of the human response to such atrocities, a number of interventions were developed over the years for victims of torture (for an extensive review, see Campbell, 2007; McIvor & Turner, 1995). Some models are based on a psychodynamic approach (Holmquist, Andersen, Anjum, & Alinder, 2006) or a relational/interpersonal perspective (Stepakoff et al., 2006). Others, such as ‘‘insight therapy’’ (Somnier & Genefke, 1986) and narrative exposure therapy (Bichescu, Neuner, Schauer, & Elbert, 2007; Neuner, Schauer, Klaschik, Karunakara, & Elbert, 2004), are cognitive-emotive in their nature. Cognitive-behavioral therapy (CBT) techniques, which were shown to be effective with survivors of other forms of traumatic experiences, are also employed in the treatment of torture survivors (Basoglu, Ekblad, Baarnhielmc, & Livanou, 2004; Palic & Elklit, 2009). However, none of these models have received sufficient empirical support. Most reports on the effectiveness of the various interventions are descriptive or impressionistic, and the intervention studies are frequently limited by a small sample size (e.g., Bichescu et al., 2007), low response rate or high attrition (e.g., Tol et al., 2009), lack of control group or randomization (e.g., Palic & Elklit, 2009; Stepakoff et al., 2006), and unstandardized measures (e.g., Manneschmidt & Griese, 2009). Overall, most of the studies to date in torture survivors show small to moderate effect size. That is, many of the participants continued to demonstrate high levels of disability or did not reach subclinical levels of distress following the intervention (e.g., Palic & Elklit, 2009; Tol et al., 2009). While the intervention models described above are quite different from each other, they all share a common and important therapeutic feature, namely the motive of testimony. As previously suggested, the healing relationships rely on truth telling and full disclosure (Herman, 1992). Many survivors enter therapy after a long period of silence and denial. In these cases, the clinical setting is the first place in which the complete story of the humiliation and atrocities is told and heard. The therapist’s role as a witness carries a special significance in the case of extreme cruelty and injustice. Indeed, there are various indications for the therapeutic power of testimonies, in which survivors’ stories are being recorded and documented, as part of therapeutic or legal procedure (Agger & Jensen, 1990; Agger, Raghuvanshi, Shabana Khan, Polatin, & Laursen, 2009; Cienfuegos & Monelli, 1983; Igreja et al., 2004; Weine, Kulenovic, Pavkovic, & Gibbons, 1998). Testimony therapy has both private and public elements. The private aspect relates to the survivor’s need to create an integrative narrative of his or her traumatic experiences. The public aspect relates to the survivor’s striving for justice, thus may serve political or judicial purposes. As previously suggested by Agger and colleagues (2009), it links the healing process at the individual or micro-level to the societal or macro-level. To the best of our knowledge, no study to date has examined the relative unique contribution of the private and public aspects of this therapy to survivors’ healing. Yet, of special interest is the fact that one of themost effective therapeutic procedures is often conducted by nonprofessionals, Opinion
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Jun 12, 2020
Nicole Lemon 
Open Access