Public service interpreting event Aston University, Birmingham December 5, 2012

1. Mental Health InterpretersDr Beverley CostaMothertongue multi-ethnic counselling www.mothertongue.org.uk Public service interpreting event Aston University, Birmingham December 5, 2012

2. 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

3. 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 • 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

4. However… Speaking a non-native language in therapy can have therapeutic benefits e.g.: Emotional ExpressionMaureen, 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).

5. 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

6. 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.

7. 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

8. Why is interpreting in a Mental Health context different from interpreting in another other context- for example, with a lawyer?

9. 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!

10. Some fears of the interpreter • Jargon • Emotional overload • Risk • Role in the therapeutic relationship • Lack of knowledge/context • Clinician’s competence

11. 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.

12. Some fears of the clinician • 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

13. Supervision of Mental Health Interpreters • Managerial supervision • Professional support and mentoringe.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

14. 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?

15. 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

16. 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 

17. Further reading: Tribe and Raval(2003) Working with Interpreters in Mental Health, Brunner RoutledgeCosta (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, supervisionandsupport 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