Found in translation

About 13 percent of the U.S. population is made up of immigrants, all of whom face the stresses of adapting to a new culture. At the same time, many are also grappling with the traumas of war, poverty and natural disasters.

To help these clients, clinicians are increasingly turning to language interpreters who are trained in mental health issues — professionals who are in short supply. But such training is therapeutically essential, say experts. Without a solid grounding in mental health, interpreters who work with psychotherapists can actually do more harm than good. Untrained interpreters may, for example, censor psychotic, profane or sexual content out of fear, embarrassment or a desire to “protect” the client. They may also make subjective decisions about what the client means, discuss the therapy with outsiders or omit vital information about traumatic events and feelings because they’ve been through a similar situation themselves.

Well-trained interpreters can make a huge difference in treatment outcomes, says Katherine Porterfield, PhD, senior psychologist at the Bellevue/NYU Program for Survivors of Torture. “It’s almost like a skilled interpreter becomes invisible, and the language starts to flow between you and the client,” she says. “It’s wonderful to have a person be a bridge between two people who don’t speak the same language in a way that allows psychological care to take place.”

Fortunately, training programs are springing up nationwide. California psychologist D.J. Ida, PhD, and colleagues, for instance, have piloted a 40-hour training program for mental health interpreters that Ida hopes to turn into a statewide program, and she’s launching a similar program in Texas. Other states, including Massachusetts and New York, already have programs in place (see “Resources”).

Meanwhile, psychologists who work with these populations are becoming savvier about advocating for better interpreter training, though there is still a long way to go in making specialized classes more common and standardized, says Olga Acosta Price, PhD, who directs George Washington University’s Center for Health and Health Care in Schools and works with programs that serve immigrant and refugee children.

Until more options exist, there are ways to ensure that the interpreter relationship benefits all involved, experts say. They recommend you:

• Reach out. States and cities with large immigrant and refugee populations are more likely than less populated areas to have interpreters with mental health training. Ask local language interpretation services, hospitals, universities and state or county mental health departments for recommendations. If you can’t find a mental health specialist, try to find a medical interpreter. Many of these professionals have received at least some mental health training, and they are easier to find.

• Don’t rely on family. Avoid using clients’ family members as interpreters, says Bellevue/NYU’s Porterfield. It can be tempting to use family because they are readily available and free, but having them translate sensitive or traumatic material can be highly distressing, especially for children, says Porterfield. In addition, patients may withhold important information to protect their family members, she says.

• Explain therapy basics. Any interpreter, but especially those who lack mental health training, needs to be briefed on the therapy process and the importance of maintaining confidentiality and boundaries. Be sure to emphasize the importance of translating everything they hear, says Joy Connell, who trains mental health interpreters and is board co-chair for the National Council for Interpreting on Health Care. In particular, interpreters need to be primed not to smooth over incoherence or discontinuity in speech, which can tip therapists off to mental health problems.

“It’s important to let them know that we need to hear all of the client’s material — that how a statement is uttered is just as important as what is uttered,” says Connell.

Debriefing is also important, says Porterfield. After a session, ask the interpreter to describe discussions that were confusing or difficult to translate. Such information can provide greater insights into a client’s condition.

• Help the interpreter. Make the interpreter’s job easier by speaking in short phrases or words that are easy to process but maintain your meaning. Be sure to remember that certain Western metaphors might not make sense in another language. Also, try to build a rhythm of speech that’s natural. “You don’t want it to be stilted or awkward or really slow or too fast,” says Maryam Kia-Keating, PhD, psychology professor at the University of California, Santa Barbara, who has worked with refugee families. And use a seating arrangement that promotes optimal conversation between you and your client. For example, ask the interpreter to sit at your side so you’re directly facing the client while the client maintains contact with the interpreter. (The optimal arrangement may vary depending on the interpreter’s role in the process and your client’s preferences.)

• Give community members extra training. If the interpreter comes from the same community as the client, maintaining boundaries and confidentiality is especially important because they may run into one another or have friends in common, says Porterfield. Talk about this with the interpreter before therapy as well as in session so clients feel confident their revelations will remain safe, she says.

Also, recognize that translators may have traumas in common with your clients, Ida adds. “If you have a Cambodian interpreter who’s interpreting for another Cambodian and they’re talking about the horrors they experienced under Pol Pot, it can be intensely traumatic if they don’t have proper training and support,” she says.

Interpreters and clients may also come from warring factions in their countries, so check for this possibility as well.

• Forge an alliance. Build a good relationship with your interpreter from the start by, for example, asking how you can make his or her job easier. Forging a bond can make interpreters feel like part of the therapeutic team, says Connell. Also recognize that the interpreters will know a culture better than you do, Ida adds.

“They’re not just tape recorders. They’re human beings and they’re bringing in their cultural expertise,” she says.

To help maintain your clients’ comfort, try to keep the same interpreter throughout treatment, Kia-Keating adds. “They’ll have a better understanding of what’s going on in the case,” she says.

Tori DeAngelis is a writer in Syracuse, N.Y.