Working with Interpreters in Psychological Therapy

The Right To Be Understood

Jude Boyles, Nathalie Talbot

• Publisher: Routledge
• Year: 2017
• Topic: Psychology
• eBook ISBN:
  9781351987226
• Subtopic: Mental Health in Psychology
• Index: Psychology

This book is a practical and helpful guide for therapists that outlines best practice in working with interpreters. It provides an accessible tool for therapists working in a range of settings from small unfunded therapy teams in the voluntary sector to primary care work.

Working with Interpreters in Psychological Therapy has been written collaboratively by a therapist and an interpreter working in the refugee sector. The writers reflect upon how therapists can manage some of the complex dynamics that can occur in the triadic relationship and explore how the presence of an interpreter can bring additional psychological benefits to clients.

This book is essential reading for therapists working in cross-cultural settings, as well as the organizations in which they work.

1  Preparatory work and booking an interpreter for the first time

If a therapy service is new to working with interpreters, and has some choice in which interpreting agency can be approached, it can be useful to seek advice from other therapy services working with refugees or non-English speaking communities. There are often many interpreting and translation services in any given area, but some may not use qualified interpreters. Try to approach an agency that is trusted in the therapy sector. Some third-sector therapy services may have their own bank of qualified freelance interpreters, and may be willing to share their details.

It can be useful to set up a meeting with the interpreting agency, and be prepared to ask some questions about their processes to ensure the safety of clients. The differences between a professional interpreter and a non-qualified interpreter are significant.

Once an agency has been identified, it can be very helpful as a start to offer interested interpreters a training session on the work of the therapeutic service, outlining the therapeutic approach and which client groups are supported. Clarity on whether the work is long-term or brief is an important theme to cover on the training as long-term therapy can impact differently on the interpreter. Miller et al. in their study noted how the long-term nature of refugee work alongside the intense material explored sets interpreting with refugees apart from interpreting in other settings (2005). Services might offer long-term therapeutic work specifically with refugee populations, young people and/or families, or survivors of sexual violence, or it may be a generic service to all communities, offering mostly short-term interventions within a primary care counselling setting.

Delivering training can both equip and prepare the interpreting team engaged, but also gives a clear message to interpreters that therapists are keen to work alongside them, value their skills and want the interpreting team to be fully aware of the type of work they will be engaging in and its potential impact. Outline what is expected as well as what the therapists can offer interpreters: a pre-briefing, a debriefing and additional support and supervision if required.

If the therapy team is working with trauma or is a crisis service, describe the types of difficulties interpreters can expect to work with. Most therapeutic work involves suicide risk assessments, and so providing some teaching on the nature of suicide risk is always helpful. Our experience shows us that without specific training on trauma, interpreters seem at greater risk of vicarious trauma. If the service works with perpetrators of violence, such as in a men’s prison setting, ensure that there are male interpreters available and that the interpreting team is informed and given a choice about working in this field.

Providing a full day’s training might not be possible in some settings, but at the very least, ensure that there is a meeting between the interpreting and therapy teams. This can be a productive first step to building good working relationships. Without this introduction and an exchange of guidelines and expectations, there can be misunderstandings that impact directly on clients.

At the end of each section we have included a set of brief guidelines in bullet point form that follow the narrative. Interpreting agencies will have their own code of practice and qualified interpreters will also have the ethical framework and code of practice of their professional body.

Establishing that both interpreters and therapists have a senior manager to approach in both services when there are problems is crucial. Inevitably there will be occasions when the interpreter is unhappy at the conduct or approach of the therapist, or the therapist may need to share concerns with the interpreting service manager about an interpreter’s English (or first language) not being sophisticated enough for psychological therapy. Either way, a pathway to address concerns from both sides is needed.

Once a therapy service has established that the agency has engaged a qualified interpreting team, booking arrangements will need to be discussed.

‘The right to understand and receive appropriate communication support is a civil right and fundamental to an inclusive and democratic society that seeks to ensure that it provides for the needs of all its citizens’ (Scottish Translation, Interpreting and Communication Forum, 2004: 6).

It almost goes without saying that the therapist should aim to use the same interpreter throughout the therapeutic contract. This need for continuity should be made explicit to the agency to ensure that an interpreter who is due to take a long break, or who has limited availability, is not booked for an assessment. Once the therapist has identified an interpreter he or she is happy to work with, the interpreter can be named and pre-booked in advance for the duration of therapy. Ask the agency not to send another interpreter if, for any reason, the usual interpreter is not available, and to contact the therapy service first.

Therapists should state the gender/language and dialect of the interpreter required when booking and also state the country of origin and/or region if this is important for the client. It is both acceptable and client-centred to be very specific when booking a new interpreter, to avoid communication difficulties in the first session. Assessment sessions are important in terms of engagement between client and therapist and booking the most appropriate interpreter for the session is a priority. Poor communication can significantly impact on the depth of the work that can be achieved and so it is acceptable for example to ask for an Iraqi male – Arabic interpreter or Swahili (Democratic Republic of Congo [DRC]) female interpreter.

It is important never to assume that the stated language on the referral information is the preferred language of the client for therapy. We have discovered that the choice of language in therapy is far more nuanced than the simple ‘first language good, other languages bad’ formula (Costa, 2011: 20). There are frequent assumptions about what language an individual speaks and prefers, and so, where possible, ask prior to booking. If the language/dialect or the gender fit is not appropriate, the therapist can use the first session as an opportunity to explore what language is preferred and arrange this for the follow-up session. Bear in mind that stated nationality does not necessarily tell you what language is best to use in therapy.

It is also a good idea to find out if there are differences in dialects within a language – for example, the lingua franca Swahili is not the same spoken in Kenya as it is in Uganda and Eastern DRC; Pashto from Afghanistan and Pashto from Pakistan are dissimilar. Kurdish is a very complex language with three distinctive dialect groups: Sorani, Kumanji and Pehlewani. A guide to languages by country can be found at the website www.ethnologue.com.

Clients may choose to work in a second or third language as it distances them from traumatic experiences. However, they may find themselves involuntarily returning to their mother tongue at times of distress or despair or when processing traumatic memories. For individuals who have been tortured and/or experienced other forms of abuse, the sound of their own language may trigger traumatic memories, and so survivors might choose to have an interpreter who speaks their second or third language. However, many individuals are able to express their true feelings only in a first or second language. Particular words, phrases and emphases convey meaning within any cultural framework and are an intrinsic part of expression.

Within the services we have worked in, we have observed that on most occasions, female clients prefer a female interpreter, and within the setting we work in together now, with refugee survivors of torture, a female interpreter is always booked for female survivors. ‘The experience or threat of violence affects boundaries of wealth, race and culture. In the home and in the community, in times of war and peace, women are beaten, raped, mutilated, and killed with impunity’ (Amnesty International, 2006).

Therapists should give some thought to the setting where therapy is being delivered. Many interpreters are expected to sit in the waiting area with clients they are due to interpret for. It is preferable to provide a separate space from clients so that interpreters can prepare themselves for the session, and can recover afterwards if needed. A separate space also protects an interpreter from clients approaching them to ask questions, request translation of a letter or a medication information leaflet or try to form a social relationship. If there is no separate waiting area, then discussions with the interpreter in the pre-briefing about how the interpreter might manage these encounters will be important. Request that the interpreter gently and politely ask the client to wait to talk until the session, outlining that the interpreter must not attempt to translate or advocate for the client in any way. A reminder to not give their telephone number to a client may also be appropriate.

A further issue to be considered at booking stage is whether the interpreter is known to the client from another professional setting, or from within the community. It is our experience that if possible, it is best to use interpreters in therapy who have not interpreted for the client in other settings in order to preserve the unique and separate space of therapy. With rare languages or in situations when the client has requested a particular interpreter, the therapist may have to use an interpreter who has an established relationship with the client and prior knowledge of his or her situation and difficulties. This can create a complex dynamic, but if this is the only available triad, then it still is possible to make it work, if handled thoughtfully. We will explore how such dynamics can be managed later in the book.

On no occasion in therapy is it ever ethical or acceptable to use an interpreter who is a relative, friend or close community contact of the client in therapy. Children should never be used to interpret.

For confidentiality reasons, the name of the client is not stated at the booking stage, but interpreters should be asked to disclose immediately when they arrive at a session if the client is known to them. They do not have to give any detailed information of the setting/s in which they have met the client but have to ensure that the therapist and client are comfortable to continue with the session. If it is appropriate to progress – that is, the interpreter has met the client only in another professional setting and does not have close links – it is vital that the confidentiality policy of both the therapist and interpreter is fully outlined at the start of the appointment. The client should also be informed that it is his or her right to ask for another interpreter. Therapists can also explain the reasons why a relative or a community advocate is not suitable for therapy.

Interpreting is a highly skilled profession but appropriate credentials are not always required by translation and interpreting agencies. Unfortunately, for rare languages, therapists may be dependent on non-qualified interpreters. In many cases, interpreters have been added to an agency’s books simply because they had a UK university qualification, or have lived in the UK for 20 years and proved fluent in English, or were the only ones to speak a rare language in the region. Without training, interpreters will not have been language-tested or have had verified listening skills and an understanding of various interpreting techniques. They may also have an insufficient knowledge of terminology in their first language, as they would have been assessed mainly in English.

Many agencies claim that they provide an online training and induction but this may prove to be untrue or just inadequate. It takes up to eight weeks to complete a Disclosure and Barring (DBS or Disclosure Scotland) check; however, interpreters can be offered assignments before being thoroughly checked.

In 2012, a Russian linguist who had not trained as an interpreter decided to test the system and registered his cat Masha for the very rare Cat language. This was accepted without any valid qualifications or DBS check. This same linguist also registered online and on his mobile application was offered work straightaway (BBC News, 2012).

Questions for the interpreting agency:

• Are the interpreters qualified and to what standard? Request that interpreters have a Diploma in Public Service Interpreting (DPSI) or equivalent, such as Ascentis Level 3 course in community interpreting or Chartered Institute of Linguists (CIOL) Diploma.
• Are the interpreters required to undertake a regular DBS check (Disclosure and Barring Service, or in Scotland, Disclosure Scotland) and are references taken up prior to acceptance by the agency? The DBS should be enhanced.
• Do members of the interpreting team also work for the Home Office? It is likely that individuals seeking asylum in the UK will not feel safe with an interpreter working alongside decision makers within the asylum process.
• Ask for a copy of the Code of Practice and/or Code of Conduct of the interpreting agency, which should include themes such as confidentiality and impartiality.
• Ask what languages are offered, and whether there are male and female interpreters in the team for the languages most frequently required in the service.
• Ask for the booking process, and request that when a named interpreter is booked, this interpreter is not replaced by another if she or he becomes unavailable.
• Ask what internal training has been provided to the interpreting team.
• Ask what supervision arrangements are in place. There may be none, but it is important for therapists to know what support the interpreting agency provides as this will inevitably lead to therapists being required to provide ongoing supervision and support for interpreters.
• Ask which interpreters have experience of working within psychological therapy and mental health settings and request for these to be booked where possible.
• Ask that any interpreters arriving for an interpreting booking at the therapy agency disclose immediately to the therapist if the client is known to them in any capacity, either professionally (they do not need to disclose how) or personally.

Guidelines once an interpreting agency/freelance team has been engaged:

• Provide training to the therapy team on good practice in working with interpreters as well as outlining the role of the interpreter.
• Train and brief the team of interpreters who have experience of/or are committed to working in psychological therapy on the work of the service.
• Agree that when an interpreter is booked for a new client or therapist, he or she is offered a half hour of pre-briefing with the therapist.
• Give some consideration as to where interpreters wait for clients so interpreters are protected from being approached by clients seeking advice or social contact.
• Establish clear booking arrangements and ensure the agency will fulfil your requests in terms of language and dialect/gender and availability of interpreter on a regular basis. This is to ensure you can provide consistency of interpreter for the client.
• Establish clear lines of communication between both the therapy and interpreting agency so any concerns can be addressed speedily to reduce the impact on clients.

2 The role of an interpreter

From a social constructionist approach, Mudarikiri writes that ‘relationships between people can be thought about as existing within the web of meanings that are created by language’ (2003: 183). The therapist, interpreter and client are in a relationship together and how they communicate and understand each other is determined by the context in which the dialogues are taking place.

Language is complex and the task of linguistic interpretation is a highly challenging process, as it involves not just words but also interpreting the meaning behind what is being said. ‘Each different language makes particular meanings possible and allows us to experience certain aspects of ourselves’ (Mudarikiri, 2003: 183).

It is usually not possible to simply translate from one language to another. ‘The interpreter has the unenviable task of rendering a meaningful translation that reflects all the levels at which communication is taking place’ (Mudarikiri, 2003: 189). Meanings may be coded or there may not be a word for a concept that is part of the cultural landscape of a country, such as the language of trauma prevalent in the UK. Alongside this, how we understand health, express distress and seek help varies from culture to culture. ‘Interpreting requires more than just word for word translation, and advances meaning in the fullest linguistic and cultural sense, so that two people can understand each other beyond their words’ (Raval, 2003: 16).

It is often assumed that only interpreters require training on the role of therapy, but our experience is that therapists frequently misunderstand the role of the interpreter or do not appreciate the complexity and skills of the profession. Delivering training for therapists on the interpreter’s role is crucial in creating a working alliance between practitioners where interpreters feel that their skills are understood and valued.

Therapists do not always manage the dynamic in the triad well because of a lack of understanding of the role, as well as other anxieties about having a third person in the room and the exposure of having a witness to their work.

Many interpreters working within non-specialist settings may not practice skilfully, with an awareness of the potential impact of their presence on a client. However, if therapists are aware of what constitutes good practice, they are much more likely to be clear with the interpreter about what they require and be confident enough to challenge when the interpreter is not working appropriately.

The task of interpreting is highly skilled. The role carries significant responsibility and requires high levels of concentration, as well as sens...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Preface
• Acknowledgements
• Introduction
• 1 Preparatory work and booking an interpreter for the first time
• 2 The role of an interpreter
• 3 Briefing the interpreter
• 4 Good practice in working with interpreters in therapy
• 5 Debriefing the interpreter
• 6 Managing challenging dynamics
• 7 Managing shifting power dynamics in the triad
• 8 Support and supervision of the interpreter
• 9 Ending the three-way relationship at closure of therapy
• 10 Interpreting on the phone or via Skype
• 11 Working with children and young people
• 12 Interpreters in couple and family therapy
• 13 Interpreters in a therapy group setting
• Summary
• References
• Index