Working with Interpreters
For most of us working with interpreters is not a particularly easy task. Some of the concerns sited by therapists is that is slows the whole therapeutic process down and it carries with it the concern that in the interpretation both the meaning for the therapist and the client can get 'lost' somewhere.
Patricia Eschoe, an experienced cognitive behavioural psychotherapist has worked with, and trained people to work with interpreters for many years and wanted to share some of her experience in this area with you. Linda Matthews, many of you will know from her work with us here in The Psychology Service, is a Consultant Psychotherapist and has particular experience of supervising people who work with interpreters. According to Patricia and Linda working with interpreters can be complex but not impossible.
First and foremost there is a need for the client and therapist to develop a shared explanation of what is being said (Kaufert 1990). Secondly the therapist, client and interpreter all play an important part in what becomes available for discussion and the subsequent information that then emerges from conversation. Cultural factors and supervision need to be addressed. Tribe (2003) talks about four levels of interpretation:
- Linguistic - words and meanings
- Metaphorical - contextual knowledge
- Digital - non verbals
- Cultural - practices - beliefs and values
One of the difficulties for the interpreters and, therefore, for the therapist is that if they are not actively participating in the process of therapy they can become 'over hearing' and their understanding of what is being spoken can decrease as the dialogue progresses (Clark 1992-1996) resulting in misinterpretations taking place. Therefore, the importance of factors such as the positioning of the therapist, interpreter and client (the psychotherapeutic triad) is vital, body posture, nods and utterances are all important factors and enable the client to feel that they are being engaged with on all levels.
Good quality supervision is also important for the therapist to examine the triad and the part they play in it. Particularly if we bear in mind the assertion that it is virtually impossible for an exact translation of an utterance/text to be made from one language to another (Roy 1999). Interpreters are more often used translating for conferences or texts (word for word transcribing or reading) which differs greatly form interpreting conversation, particularly in a therapy setting (meaning, innuendo etc). Interpreters can be faced with a quandary as to what to leave in and what to leave out.
It is worth remembering that interpreters may sometimes expand, add or condense the information you are giving (Reiben et al). The 'performance' of the interpreter in the session is dependent on their confidence, experience and competence (Mason 2001). There are times according to (Grasska & McFarland 1982 in Tribe) that interpreters cloud the communication between therapist and client with everyone ending up frustrated. It is important therefore to have what Mason calls 'visible participation' - where the psychotherapy is not static but is seen as a process of meaningful utterances and exchanges. Therefore it could be argued that it is necessary for even a little time to be spent with the interpreter before the session begins to ensure clarity for them of their role and to help them understand that they are an 'active' participant in the relationship network with the client when the three of you are in the room. For example interpreters may have no knowledge of the language of psychotherapy or what a psychotherapeutic approach is. Even five minutes to check this out and have a brief discussion can be invaluable in terms of how the interpreter goes on to translate what is being said.
For the client there can be a myriad of concerns ranging from a difficult alliance between them and the interpreter which may not be obvious to the therapist, power dynamics, feeling interrogated, subtle nuances that the therapist is unaware of in terms of culture. Therefore flexibility is important from the therapist as the usual history taking may not be the first step. This of course causes a dilemma when we need to gather information in a limited time. The question is how do we inspire the reaction and answers we want from comprehension in a hearer who's world views are shaped by a different series of linguistic and social correlations? For example shame and fear of madness are present for the client whose culture does not recognise any form of poor mental health. In China and Japan they do not have a word for depression with the nearest translation being a sadness of the heart (Burnett and Peel 2001). Therefore the first steps of building a rapport is being as inclusive as possible and is vital in order to begin to build trust (Beck & Emery 1985) to elicit the information we need to enable us to deliver good quality therapy.
The key elements that the therapist has responsibility for when using an interpreter are:
a) to reinforce the interpreters ethical and professional obligations particular to a therapeutic setting
b) the need to control the pacing, socialisation and rapport within the session
c) holding of the trust in the triad - with the client's best interest being central to this
d) enabling of appropriate 'turn taking' in the communication
e) the use of clinical supervision
f) the recognition that when using an interpreter that it is not 'the same as usual' when delivering the therapy.
g) to make a little time to familiarise/educate themselves about the race/culture of the person they are going to be seeing - for example issues such as gender, Casts, myths, touch, boundaries. All these vary from culture to culture.
People often ask what will make it easier in the room particularly when the less than ideal situation arises of it not being the same interpreter for each session - something we may have no control over. This is difficult as essentially the same process has to be repeated over and over which is disruptive both for the client and the therapist. Where possible having consistency through the use of the same interpreter for each episode of therapy would be best.
When the actual session is up and running then as therapists it is important for us to try to further enable the process as follows
- use short statements and questions
- allow time for the translation to take place and a reply to be made
- be alert to long discussions between the client and interpreter
- seek clarity as often as is needed
- avoid using the third person - first person exchange is more respectful and inclusive
- remember to look at your client NOT the interpreter
- have the seating correct so that therapist and client are in the therapeutic position with the interpreter to the side
- as the therapist, lead, structure and guide the triad (Fox 2001)
If you are supervising someone who is using an interpreter it is equally important for you to mirror some of the learning that the therapist has had to engage with particularly in terms of cultural and racial differences. It is encouraging for the therapist and models good practice if the supervisor is able to inform themselves for example, about the impact of power, colonial history and how it may impact on effective practice between the therapist and the client. Do not be afraid to ask your supervisee what you perhaps need to know to enable this. On the basis that clinical supervision is a two way process then this is both respectful and encouraging for the supervisee whose experience in the therapy room may have left them feeling quite de-skilled This then gives the supervisor and opportunity to prepare for the next session.
As a supervisor you also need to be aware of the parallel processes that may be taking place in the supervisors room and to not over collude with the therapist particularly if you are both of the same culture.
Specialist training for supervisors and therapists in the area of working with interpreters would be great but not readily available. However the British Psychological Society (BPS) have published an excellent paper 'Working with Interpreters in Health Settings' guidelines for psychologists (2008) which is equally useful for working in the Private Sector and is worth a read. It has 12 sections including the use of telephone interpreters and psychometrics and offers helpful and easy to use guidance on working with interpreters.
- Beck AT & Emery G (1985) Anxiety Disorders and Phobias. USA Library of Congress Cataloguing
- British Psychological Society (BPS) (2008) 'Working with Interpreters in Health Settings' guidelines for psychologists
- Clark H (1992, 1996) Using Language, Cambridge University Press
- Fox A (2001) An Interpreters Perspective. Magazine for Family Therapy and Systemic
- Grasska & McFarland in Tribe R& Hitesh R (2003) Working with Interpreters in Mental Health. Brunner Routledge East Sussex
- Kaufort J (1990) Sociological and Anthropological Perspectives on the Impact of Interpreters on Clinician/Client Communication. Sante Culture Health (V2-3) 209-235
- Tribe R & Hitesh R (2003) Working with Interpreters in Mental Health, Brunner, Routledge, East Susses
- Roy C (1999) Interpreting as a Discourse. Oxford Studies of Sociolinguistics. Oxford University Press. New York