Mental Health Interpreters
Dr Beverley Costa
Mothertongue multi-ethnic counselling
www.mothertongue.org.uk
Public service interpreting event
Aston University, Birmingham
December 5, 2012
Mothertongue multi-ethnic counselling service
• Culturally and linguistically sensitive professional counselling
service for people from black and minority ethnic communities
• Counsellors, patients and NHS professionals reported
dissatisfaction form agency interpreters who were not trained
and supervised to work in a Mental Health context
• Mothertongue responded by creating training for interpreters
and clinicians in collaborative working , a training DVD and a
dedicated Mental Health Interpreting Service which is funded
by the local PCT and Health Authority
Why is it frequently so important to be able to speak
your Mothertongue for Mental Health
interventions?
Learning a language early promotes heightened
emotionality of native language compared to
additional language because:
–
Family context of learning
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First language learning co-evolves with emotional regulation systems
–
Native language has greater connections with subcortical brain
structures which mediate arousal (including amygdala-mediated
learning)
Catherine Harris(2006 ) When is a First Language More Emotional? Bilingual Minds , Anna Pavlenko Publisher: Multilingual Matters Ltd
However…
Speaking a non-native language in therapy can have
therapeutic benefits e.g.:
Emotional Expression Maureen, English L1, Italian L2
“I prefer to express my anger in Italian because I do not hear the weight of my
words so everything comes out quite easily. Which unfortunately means I probably
hurt people more than I intend to!” (Dewaele, 2010)
Protective Factor and Repair
A language learned after the early childhood years can serve as a protective
psychic defence. (de Zulueta, 1984,1990).
“…where an individual is equally fluent in two languages the most significant
factor in increasing the quality and emotional content of the recall is the language
and context in which the incident was encoded.” p.11 (Tehrani, 2009).
Challenges for interpreting
in a mental health context
(1)
Language
“Every language contains its own naïve picture
of the world including its own
ethnopsychology”
( Apresjan, 1974)
• Emotional concepts, metaphors and values do
not have direct equivalents in all languages
• The importance of the client’s own voice
A client’s experience of using an
interpreter
You are telling something,…..
You revolt at everything…
You have problems …
You want to tell them to the doctor…
You know Turkish ..
You can’t tell them in English …
That’s number one... already enters into you like an arrow.
Secondly...a second person…that person knows your language
She is someone from your own culture,
That is how you think..
You talk about what you have lived through…
Wondering what she is thinking.
That enters you as the second arrow.
It makes you upset, of course it makes you upset.
Challenges for interpreting
in a mental health context
(2)
The context
•The nature of therapeutic intervention
•The relationship, roles, power, alliances
and tensions
•The triad v the dyad
Why is interpreting in a
Mental Health context different
from interpreting in another
other context- for example, with
a lawyer?
Why interpreting in a mental health context
is different
• Solicitor, has information, which the interpreter does
not have and which the client needs
• For the client, the presence of the other professional
makes sense
• A MH clinician may appear to have nothing to offer
the client, especially if they cannot prescribe
medication
• Clinician mainly only offering relationship at first
• For the client, the interpreter, who they understand,
seems like a better option for that!
Some fears of the interpreter
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•
•
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Jargon
Emotional overload
Risk
Role in the therapeutic relationship
Lack of knowledge/context
Clinician’s competence
Clinicians who are not trained to work with interpreters may defer all
responsibility to the interpreters or try to undermine them by, for
example:
•requiring interpreters to break bad news to clients
•expecting interpreters to manage the consequences of misjudged
interventions
•wresting control from interpreters by discounting them or excluding
them from the process
•refusing to be available for the pre and post briefing meetings
•ignoring the needs of interpreters
These are very delicate situations for interpreters where they will need to
be assertive and to remind professionals of the limits and responsibilities
of both their roles. At the same time they need to be sensitive to the
clinician’s authority in the session.
Some fears of the clinician
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Am I being translated accurately?
Will there be enough time?
Trust e.g.confidentiality,reliability,consistency
Can I establish a rapport/connection with client?
Staying in control of the session
Perez Foster proposes that “the use of a translator in a
psychodynamic or psychoanalytically oriented treatment
approach would almost be untenable (…) for a variety of
reasons which include the complexities of transferential
projections.” Perez Foster, R. (1998) The Power of Language in the Clinical Process:
Assessing and treating the bilingual person. New Jersey: Aronson
Supervision of Mental Health
Interpreters
1.
2.
3.
4.
5.
Managerial supervision
Professional support and mentoring e.g. The interpreter describes a
situation where the clinician leaves the room and leaves the interpreter
on her own with the client
Case management e.g. The clinician invites a family member into the
room and allows her to interpret informally from time to time
Clinical supervision e.g. The interpreter suspects the client is lying to
the clinician ( because of some cultural misunderstanding) and thinks
the client realises that this is what the interpreter is thinking
Personal/pastoral support e.g. An interpreter has been interpreting for
a woman whose father recently died from cancer. She is very distressed
and is suffering from depression. The interpreter is finding it very hard to
stop thinking about her after the sessions
Some fears of the client
• Will the interpreter know my family?
• Will they tell anyone else?
• Will the interpreter judge me as we are from
the same community?
• Will we be political enemies?
• Will they translate me accurately?
How do we get the interpreting service
we need?
• Dedicated training programme for all potential MHIs to
include : triadic relationships; the nature of therapeutic change;
therapist behaviour; the nature of power in the therapeutic
relationship; the extent and limitations of the respective roles;
interpreter behaviour and practice in MH context
• Rigorous recruitment and selection procedure
• Quality standards and codes of practice monitored and
adhered to
• Training of clinicians to work effectively with interpreters, to
engage actively with language difference, to maintain control
of the session and to maintain their clinical responsibility so
that they create a safe context in which clients feel they can
trust the process
• Supervision and evaluation of service
Tips for ways to increase client trust and safety in the
therapeutic process
Therapist:
Be explicit and transparent in the way you work
Reassure client about how important hearing their message and their voice is and how you will do
your best to listen very carefully to them
Be explicit about the whole process
Explain that you will be summarising and checking your understanding with the client regularly
Reassure the client about interpreting accuracy/ confidentiality
Check with how the client wants to be interpreted e.g. every sentence , longer chunks etc
Time: manage the time so that the client has enough space to express themselves
Think about the timeframe in advance
Communicate directly to the client
Think about how the client will feel held and safe in the session
COLLABORATE with the interpreter
Interpreter
Be present, be interested and be human , so that the client feels listened to
Be explicit and transparent in the way you work
COLLABORATE with the therapist
Further reading:
Tribe and Raval(2003) Working with Interpreters in Mental Health, Brunner
Routledge
Costa (2011) When three is not a crowd. Professional preparation for interpreters
working with therapists, ITI Bulletin, January-February, 2011
Managing the demands of mental health interpreting: why training,
supervision and support are not luxuries, ITI Bulletin, March 2011
For more information about the Mothertongue Mental
Health Interpreting training DVD and the training
package, please contact:
Mothertongue multi-ethnic counselling service:
www.mothertongue.org.uk
info@mothertongue.org.uk
T: 0118 957 6393