Specifics of the psychologist’s work with people in GDCs and standards of the psychologist’s work

Zofia Żmijewska – psychologist, psychotherapist working in integrative and systemic approaches (undergoing certification), dissociative disorders diagnostician (undergoing ESTD certification) describes her work in Guarded Detention Centre. The article comes from report "Everyone around is suffering".

I have been part of the PMF psychology team since August 2021 and have been providing psychological telephone interventions for people in detention since January 2023 (more about this topic can be found on page 59 – editor’s note), as well as meeting directly with migrants in the guarded centre in Białystok.

I would like to briefly summarise my work experience of more than a year in guarded centres. I worked in a two-person sub-team with Kamil Kamiński. For most of that time we were the only psychologists in Poland supporting people in GDCs on behalf of a large NGO, with all the resources provided by the Foundation.

It is a special experience. Conducting consultations with clients in detention is a unique experience, mainly due to the constant confrontation with the conditions found in the facilities and the internal (unwritten) rules, which, in my opinion, differ from those contained in the Code of Criminal Procedure [1], the Border Guard Act[2] or in the adopted Code of Ethics [3]. The practice of crisis intervention at GDCs forced us to develop new working standards that take into account both the ethics of the psychological profession and other laws that we respect and are in the habit of following. Similarly, the personal and psychological situation in which our clients – migrants deprived of their freedom and rights – find themselves is also unique.

Telephone interventions

The formula of psychological work conducted over the phone is unusual for a number of reasons. The relationship established in this way is very different from that built in an office, where we can see the client, can respond to any non-verbal messages, but also show support or understanding through body language. In this situation, our main working tool is the voice – i.e. the melody, tempo, timbre and dynamics of the spoken word are of exceptional importance, especially as these are the only signals our client can understand at the time. Each party can only imagine what the other looks like, what physical state he or she is in, what they are wearing, at what pace they move the body and what their gaze conveys. The voice, however, can reveal a great deal of information: whether the throat is tight, how long the breath is, whether the other person is speaking faster and faster, or perhaps taking a long time to speak. When a client speaks, I can analyse these signals – often this alone tell me what the level of tension, anxiety, anger or resignation is. Only then, after hearing the translation can I determine whether there is consistency between the manner and meaning of the words spoken.

The relationship between the psychologist and the client is ‘diagonal’, no one remains passive, but it is the client who benefits from the help and knowledge of the professional. We can therefore speak of a kind of hierarchy. In this relationship, this is established by two additional elements. The first is the use of a restricted telephone number. This is a significant barrier, setting the direction for contact – it is the psychologist who calls the client, whereas the client cannot call back. The second is that the therapist contacts the client from a world of freedom, while the client is not able to make decisions for themselves.

In daily therapy practice, it is the person who needs support that comes to the office, which is a safe and familiar space. In case of telephone interventions, this element does not exist. What is very important in the process of psychological support is constancy and that the client feels that the psychologist is available to them at a specific place and time. In this case, all we can do is to make an appointment for a specific time to talk on the phone. My clients stay in touch with me by email – when something happens, they can ask for additional intervention or let me know that have been transferred to another facility or hospital. However, I most often get such messages from the lawyers and attorneys who I stay in contact with.

Working with an interpreter

The basis of the therapeutic support provided to migrant men and women in detention is the cooperation of a psychologist with an interpreter of the client’s mother tongue. Initially, it was a big challenge for me, especially when working with people I had never seen in person. It is a very unusual situation for a psychologist or psychotherapist who, like me, was taught to build a relationship individually, as well as for an interpreter listening to and accompanying such an intimate situation, which is normally not accessible, and the issues raised are covered by professional secrecy. There are some interpreters with whom I have developed such a close working relationship that I often find it easier to conduct consultations with the interpreter than without.

However, such a cooperation has a downside. When migrants hear my words translated by another person into a language they understand, their trust in the interpreter is often greater than in me. Therefore, during each consultation, I remind them that the interpreter will only translate my and the client’s words, without adding anything from themselves. This aims to take the responsibility off the interpreters and to lower the clients’ expectations that a person from their cultural background will ‘save’ them. I feel that migrant clients often do not have this awareness, and hearing a supportive voice that finally tells them what it is like in Poland, and humanely believes the foreigner, is simply more meaningful.

In my in-house work, I only use interpreters for the first meeting – so that the client can see what the person translating the language looks like and knows whose voice will accompany us during the session. Subsequent visits are individual, and the voice in the native language comes from the telephone. This serves to establish a faceto-face relationship: there are only two people in the office, so it is easier to look into each other’s eyes, even when the voice is coming from somewhere else.

However, I have to admit that when I carry out a consultation or telephone intervention alone, without the support of an interpreter, it is more taxing for me. A telephone conversation between two people is intimate and engaging. I do not have that time available to me where the client is speaking in a language I don’t understand, thus enabling me to collect my thoughts, take care of myself, have a sip of water, make a note of important things, etc. It is then easier to establish a relationship, whereas in crisis intervention it is not always the most important thing.

Danger of idealisation

One of the aggravating consequences of talking without an interpreter is also idealisation directed at only one person instead of two. Thus, I (rather than we) am seen as the ‘saviour’. One of the clients I contacted individually and exclusively by telephone visited me at the practice after he had left the guarded centre. It was a touching moment for me: it felt as if this one person embodied all my clients who had managed to get out. I felt like hugging him like a hero who had endured so much, survived so much and was now free. Idealisation also occurred on his end. It could be said that his idealisation of me was so great that it even prevented further psychological support. Even at the stage of working over the phone, for him I was a “saviour” with an “angelic voice”; this person wanted me to call him as often as possible, he did not like to end calls, claiming that they were the only thing keeping him alive. Such a high degree of idealisation often occurs when working with people in guarded centres, but in this case it focused on one person rather than a team providing assistance, making it more burdensome.

This experience was a good lesson not to mix roles and not to combine intervention work with subsequent support or psychotherapeutic work. Thus, it is our good practice: after the client leaves the GDC, I meet with them just once to get to know each other in person and to thank each other for our cooperation. Whereas if there is a need for further psychological help, I refer them to another specialist.

Stepping out of the role of psychologist

Working with people in detention often forces the psychologist to step out of their role. The therapist becomes something of an activist: they talk to the management of the centre, often listen to what the guards or emergency number operators have to say about alleged lies or manipulations of migrants. There are also situations where the client reports to us chronic toothache or headaches due to the lack of corrective glasses, damaged for example while staying in the forest on the Polish-Belarusian border. That is when I step out of my role as a psychologist and provide humanitarian assistance by passing this information onto the relevant services or organisations.

The most difficult interventions are those related to suicide crisis, not least because of the responsibility involved. Each time I ask myself where my role ends and what are the limits of responsibility for another person’s life.

In a standard situation, when a psychologist becomes aware that their client has the intention (i.e. plan and instrument) to commit suicide, they are obliged to report this immediately to the emergency number: 112. Whereas in case of people in detention, we pass information about suicidal thoughts, tools and intentions to the head of the guarded centre or to the person on duty. If the facility accepts the report, the responsibility of the psychologist ends. The problem is that it happens that the centre refuses to accept the report. It is then my responsibility to initiate the procedure and call for medical assistance. However, there is never a guarantee that the operator will accept my report or that doctors will be allowed into the facility once the ambulance is dispatched. In addition, we report past unsuccessful suicide attempts shared with us by our clients. Sometimes the border guard was the person who interrupted such an attempt, but the procedure for dealing with a suicide crisis was not initiated.

We report any such negligence on the part of the GDC in the form of a complaint submitted to the Ombudsman, for whom this forms the basis for an on-site audit. Unfortunately, I often hear from clients in detention that they are frightened that contact with a psychologist outside the centre will be a premise for not getting released. However, there are also good examples of cooperation with centres, for example when the head of the facility sees a positive impact on the condition of foreigners benefiting from our support.

Diagnosis

My work involves identification of torture victims and diagnosis of post-traumatic stress disorder (PTSD), complex post-traumatic stress disorder or dissociative disorders.

One of the diagnoses I prepared was sent to the European Court of Human Rights in Strasbourg. The person diagnosed was already sitting on a plane with a deportation order. He knew what awaited him – right from the airport he was to be sent to prison, from which he would not get out alive. Next to him sat Polish families with children, flying to warm countries for a holiday. Despite that, he stayed calm the whole time; the guards had asked him to co-operate so that they would not have to struggle with him and he would not have to be carried out of the centre by four officers, like other foreigners whose deportation he had seen in the guarded centre. The intervention worked, the stewardess answered the phone, the relevant information was passed on and the man left the plane. He returned to the guarded centre. As I finish working on this text, my client had been released – after spending 15 months in the GDC.

Drawing up psychological opinions is one element of our work. We pass them onto the lawyers dedicated to supporting our clients in an asylum procedure or in cases related to release from a detention centre and sometimes in post-release compensation case. On the basis of such opinions and other documents we manage to stop deportations, bring about release, provide adequate psychological and/ or psychiatric support, hospitalisation or perhaps glasses. But why is this only happening after many interventions by a team of NGO specialists?