Treatment and Rehabilitation

Treatment and rehabilitation, as well as the diagnostics are being accomplished by multi-disciplinary team of specialists.

The Centre service includes short-term rehabilitation (crisis intervention and support), and long-term rehabilitation programmes:
1. Medical-treatment measures
• Consulting of different doctor-specialists
• Instrumental and laboratory Investigation
• Clinical Diagnostics
• In cases of necessity, client guided to other specialized medical institutions for further examination and more specific treatment.
2. Rehabilitation
• Medical – pharmacological treatment
• Massage, Manual Therapy
• Psychotherapy (individual, group, family, couples)
• Psychological consulting and conflict resolution
• Facilitation activities
• Art therapy
• Social therapy and environmental support, complex management of the case
• Legal support
• Independent Medical and Mental/Psychological Expertise

Different psychotherapy methods of trauma copping used for short-term crisis intervention: NLP, “Testimony”, “Eye Movement” etc. Social therapy method focused on revealing and solving of current problems, psychological consultations, mediation/facilitation activities, behavior– cognitive therapy etc.

The trauma-focused psycho-analysis, analytical psychotherapy, psycho-synthesis; existential analysis methods are used for long-term psychotherapy.
Treatment (Programmes):
• 1994 – 1995: Medical and Psychological Examination of IDPs – Children and Women, victims of military conflicts in Georgia. (Financial support – OXFAM /UK/). For the duration of this project, 400 children (aged 6 to 14 years) and 253 women (aged up to 18 years) were investigated and treated.

• 1995 – 1996: Medical and Psychological Rehabilitation of Women – Abkhazian War Victims (financial support – UMCOR /USA/). In total 105 women (aged up to 18 years) and 15 children (aged 4 to 16 years) who are victims of torture, raped and organized violence were treated.

• During these projects was established the RCT/EMPATHY.

• 1996 – 1997: Psychological consultation and care of IDPs (program of the Women – refugees Association, financial support – UN High Commission to Refugees). In total 120 persons – victims of war conflicts and their family members – were treated. Among them 92 civilian women and 28 civilian men (aged up to 18).

• 1997 – 1998: Consulting and care of psycho – social problems of refugees from Abkhazia in Moscow and in Tbilisi (financial support – Netherlands Embassy in Moscow). In all, 150 persons – refugees and IDPs – were treated.

• 1998: Crisis Intervention Program Ministry of Health of Georgia in the nearest war zone. In all, 60 persons – IDPs- secondary traumatized victims – were treated.

• 1999 – 2000: Rehabilitation victims of torture (state repressive persons). In total, 30 men (aged 18 to 70 years) were treated.

• 1999 – 2000: Psychological rehabilitation of women prisoners (financial support – UNV). In all, 130 women (aged 18 to 70 years) were treated.

• 2000: Monitoring and Care Children and adolescent Prisoners (financial support – UNICEF). All 21 persons (aged 12 to 18) was investigated and treated.

• 2000: Monitoring and consulting in Prison preliminary investigation isolator. In all 25 persons – 3 women and 22 men (aged up to 18) were investigated and conducted consultations.

• Since 2001: Medical and Psycho – Social Rehabilitation of Women prisoners (financial support – PRI /UK/). All 131 women prisoners, especially victims of torture, have been investigated and treated.

• From 2002: Continuing of the Project Medical and Psycho – Social Rehabilitation of Women – prisoners Victims of Torture (financial support – PRI /UK/). All 63 women victims of torture have been investigated and are ongoing of the treatment rehabilitation activities.

• 2002: Monitoring of the Living Conditions of Women Prisoners in Women Prison in Tbilisi, Project of the Women’s Club PEONI – By the Centre Empathy has been provided the Medical part of the project (financial support – OSCE).

• 2002: Monitoring and Prevention of Torture in Georgia – By the financial support of OSCE/ODIHR.

• 2002: Rehabilitation of Torture Victims – By the financial support of OAK Foundation/IRCT. Project covered activities in Pre – Trial Prison and Juvenile Colony.

• 2003 – 2005: Programme of Rehabilitation of Torture Victims in Georgia (Programme includes establishing of the psycho – social rehabilitation centres in prison system in Georgia, as well as provide assistance for refugees and IDPs torture victims and prevention torture activities on military conflict zone too.) by the Financial support of the UNVFVT and Oak Centre Support Grants, as well as by the financial support of EU and Open Society Institute. Ethnically our clients are Georgians, Russians, Abkhazians, Chechens, Ingushes, Osetians, Armenians, and Azerbaijanis. The main beneficiaries of the Centre are victims of torture and organized violence – victims of state oppression, police victims, war victims.

• 2006 – 2008 – The Programme of Rehabilitation of Torture Victims in Georgia (Funded from EU, FCO, PRI, UNVFVT, IRCT) Since 2009 the new Project “Strengthening of System of Rehabilitation for Torture Victims in Georgia” is started by the financial support of the EU, UNVFVT, IRCT.
  1. Medical and psychological study (diagnostic) program: A) Medical and psychological diagnostic by using the special prepared clinical questionnaires in accordance with ICD – 10 Revision: 1. Center “Empathy” questionnaire “Medical and Psycho – Social Monitoring and Rehabilitation Programme for Victims of Torture”, apparently with International clients monitoring program of the IRCT/ICAR /Denmark, Copenhagen/ and “Istanbul Protocol”. – Clinical/structural Interview method B) Psychological examination by using the following clinical psychological questionnaires: 1. Harvard Trauma Questionnaire. 2. Posttraumatic Stress Disorder Symptoms Questionnaire (for adults – Watson, 1991).  3. Civilian Mississippi Questionnaires (Mollica et al); 4) Shikkhan Anxiety Scale; 5) Buss – Durky Aggressive Scale; 6) MMPI; 7) BDI (Beck Depression Inventory); 8) Hamilton Depression Rate Scale; For Adolescents:  Lusher Test and “Hand Test”, as well if appropriate PTSD and other relevant scales will be used.
  2. Medical and psycho -social rehabilitation for victims of torture and ill – treatment:
A) Psychotherapy

Methods: individual, group, family.
Types: NLP, Methods of Testimony and “eye movement”, Analytical psychotherapy, Psycho – synthesis, Existential analysis, Cognitive – Behavioral, Psychodrama and role player psychotherapy etc.

B) Psychological Support: Psycho – correction, Re – socialization, by using Reality Therapy and Behavioral Therapy methods. Psychological consultations for prisons staff and victims’ family members as well.

C) Art – Therapy – by using of painting and clay modeling methods.

D) Social Therapy: By using the methods of environmental support and case management. Revealing the current problems and needs of the torture victims (prisoners and former prisoners and their family members or other torture victims and their family members). Providing the support for planning and solving their problems, client advocacy and, in cases of necessity, to collaborate with Governmental and Non – Governmental organizations having more specific directions (legal aid or other) for solving the revealed problems. Creating the Self – Supporting groups among torture victims and an active participation of such groups during social rehabilitation process (participating in the movement against torture, client advocacy or other prevention activities, etc); Facilitation activities between prison administration / or medical authorities and prisoners for conflict resolution and improvement of general situation in the prisons. Activation of the prison staff, especially health professionals and prisoners’ rights protection staff in client advocacy activities.

Main Goals of Psycho-rehabilitation Performance:

  1. Establishing of the mutual trust contact between client and therapist (Transfer).
  2. Catharsis, Abreaction.
  3. Dissociation from traumatic stress and assimilation into the life experience of the person. Change of the attitude towards traumatic stress.
  4. Discovering unused, compensatory resources of the personality and further its realization in daily life.
  5. Re-evaluation of the system of values. Development of the personality “self” structures.
  6. Improvement of social adaptation: a) Regulation of the interpersonal relationships; b) Transformation of the “Aspect of Enemy” and the aggressive energy transformation into the creative course.
The Basis Approach of Psycho-Rehabilitation Performance:

/Meichenbaum, Novaco, Everly, Girdano et al./

-  Correction of the most widespread ideas regarding stress-related reactions.
-  Giving of information to victims regarding stress-related disorders and their natures.
-  Focusing on the role of traumatic stress in developing of stress-related disturbances.
-  Leading of clients to become aware independently of the stress-related reactions and their symptoms, which have been manifested
-  The developing of the self-analysis in client’s personality, aim of which is identification of the client’s self actually stressors.
-  Informing of clients regarding the important role, which client takes in the traumatic stress therapy process.

The group psychotherapy methods are oriented on mixed target groups in accordance with Lifton models.

The individual psychotherapy methods are oriented on personality Oriental Focused Psychoanalysis. (Lindy, Green, Grace).

E) Medical consultation – General Doctor’s, Psychiatrists, Neurologist, Traumatologist’s and other needed consultations and treatment and rehabilitation, in cases of necessity providing facilitation activities with Ministry of Justice Health system or Ministry of Health several institutions for sending the patients for more specialized relevant treatment.

F) To provide independent Psycho – Physical expertise – conclusion (record) regarding client’s health condition – for Governmental structures (for ex. for Court etc) or non – governmental organizations working in the Human Rights protection sphere, especially for Ombudsman Office. The Independent Medical Records are provided by the multidisciplinary Team of Health Care Specialists in accordance with international standards of torture investigation and documentation (Istanbul Protocol, CPT Recommendations etc); Provides Forensic Psychiatry Reports according to the international standards: Kaplan and Sadock Textbook guidelines, Oxford Psychiatry Textbook guidelines or other relevant guidelines, and if required the Forensic Medicine Expertise reports.

G) For more specialized services that are not included in the Centre’s service list the clients are guided in several contracting Medical Service Centres. For comprehensive health care for VoT Centre EMPATHY has close collaboration with following Health Care institutions and other contracting authorities :
Sub – Contractors or Services:
1) Multi – profile Treatment Centre in Tbilisi – for more specialized investigations, consultations, treatment and instrumental Investigations.
2) National Centre of Oncology
3) National Centre of Therapy.
4) National Centre of Urology
5) TSMU Central Clinic
6) Yoakum and Anna Gynecology Hospital
7) Tatishvili Diagnostic and Treatment Centre
8) Physiotherapy Centre of the Orthopedic Clinic
9) Ophthalmology Clinic “Ophthalmiji”
10) Other Health Institutions and Services
11) Independent Medical Forensic Expertise Centre “Vectori”
12) Farm Firms: GPS, PSP, for Psychotropic Drugs – “Titani”

As well as for more specialized treatment Centre EMPATHY collaborates with Ministry of Health and its other institutions: TB National Centre;Research Institute of Psychiatry etc.

H)  Legal Consultation and assistance – through providing the legal consultations to VoT and their family members outside and inside of the prison institutions, support in appealing to the Court (national and International);

Re–Evaluation of the Client’s Health Condition, Post-Treatment:
  • Clinical and needed Para – clinical methods.
  • Re–evaluation using psychological questionnaires
  • PTSD tests
  • MMPI
  • Depression and anxiety evaluation questionnaires
  • Using the Empathy’s Client’s Subjective Evaluation Questionnaire
Assistance includes: Long term and Short term Rehabilitation services for victims of torture and their family members.
Overall monitoring and evaluation programme for the rehabilitation system (Includes Rehabilitation Centres (Branches – see below and Monitoring – Crisis intervention, Emergency Programme activities)
For evaluation and monitoring of the Rehabilitation System following mechanisms were set upped:
  • Centre standardized documentation (Medical Card, Consultation Forms – For Doctors; for social Workers; for psychologist and Psychotherapists; For Art Therapist, For Lawyers, Referral Forms
  • Treatment and Rehabilitation Standards created in accordance with international standards for Health Care and Ministry of Health of Georgia guidelines.
  • Centre Medical License obtained from MoH.
  • Elaborated methodology in accordance with International Standards (ICD – 10), Istanbul Protocol and other relevant health care guidelines.
  • Monthly reporting forms;
  • Electronic Data Base System that includes several items related to the client and to the course of rehabilitation;
  • Statistical Analysis of Data regarding rehabilitation system;
  • Rehabilitation Includes client’s re – evaluation mechanisms with medical, psychological re – evaluation with standardized Subjective re – evaluation questionnaire.
  • Following Registration Journals: For Medicines – medicines income and outcome registration and same outcome registration Journal for each Branch offices; Medicines Ordering Journal for Doctors and Online ordering software for Nurse.
  • Clients’ Registration Journal;
  • Visits and Consultations’ registration Journals;
  • Staff registration journal; staff outdoor visiting registration journal;
  • Social workers and clients per diems (travel from Regions) registration journal;
  • Income and Outcome Documentation’s registration Journal (two journals – one related to the patients, one – related to the Organization);
  • Every morning medical evaluation and reporting meetings’ Journal for Staff;
  • Referrals registration Journal;
  • “Hot Line” – Reporting Journal;
  • Crisis intervention and monitoring reports;
  • Discharging Clients’ registration Journal;
  • Ongoing Patients’ registration Journal.
  • Reporting system for Contractor Health Care Institutions, Farm Firm Organizations: Consultations, Investigations and Financial Reports.
  • Georgian Legislation updating software
  • Medical
  • Psychiatric
  • Psychotherapy (Individual, Group and Family)
  • Art Therapy and art work
  • Public – educational group therapy with using the movies or drama therapy
  • Physiotherapy, Laser therapy and Acupuncture
  • Counseling
  • Community visits
  • Referrals
  • Financial assistance (support for travel and accommodation for out patient type treatment for VoT)
  • Social welfare
  • family – based treatment
  • Psychological
  • Legal Assistance and Client advocacy
  • Centre is providing independent forensic expertise, medical and psychiatric/psychological, in accordance with Istanbul Protocol.
  • “Hot Line” – for immediate response and crisis intervention.
  • Training – educational and research programme
Branches of the RCT/EMPATHY and Partners